Healthcare Provider Details

I. General information

NPI: 1750994471
Provider Name (Legal Business Name): THE EDUCATED BODY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3542 FRANKLIN AVE
MIAMI FL
33133-5716
US

IV. Provider business mailing address

3542 FRANKLIN AVE
MIAMI FL
33133-5716
US

V. Phone/Fax

Practice location:
  • Phone: 305-396-1861
  • Fax:
Mailing address:
  • Phone: 305-396-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JACQUELINE TIBBETT
Title or Position: MANAGER
Credential: PHD-LMT
Phone: 305-396-1681