Healthcare Provider Details

I. General information

NPI: 1982419461
Provider Name (Legal Business Name): BODY DOJO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8958 HILL DR
IRWIN PA
15642-3112
US

IV. Provider business mailing address

1059 GIULIA DR
IRWIN PA
15642-4187
US

V. Phone/Fax

Practice location:
  • Phone: 724-755-3020
  • Fax:
Mailing address:
  • Phone: 412-722-3618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COREY DEASY
Title or Position: FOUNDING PARTNER
Credential:
Phone: 412-722-3618