Healthcare Provider Details

I. General information

NPI: 1144371915
Provider Name (Legal Business Name): BODY BY GEOFF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 WASHINGTON PLZ N STE B LAKE ANNE VILLAGE CENTER
RESTON VA
20190-4346
US

IV. Provider business mailing address

1609 WASHINGTON PLZ N STE B LAKE ANNE VILLAGE CENTER
RESTON VA
20190-4346
US

V. Phone/Fax

Practice location:
  • Phone: 703-464-5559
  • Fax: 703-464-5549
Mailing address:
  • Phone: 703-464-5559
  • Fax: 703-464-5549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES KIMON SMITH
Title or Position: PRESIDENT
Credential:
Phone: 703-464-5559