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General NPI Number Information
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NPI Number | 1144798083
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Entity Type | Organization
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Legal Business Name | BODY LOUNGE PARK CITIES
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Dates
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Enumeration Date | 11/08/2018
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 6803 HILLCREST AVE
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City | DALLAS
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State | TX
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Zip | 75205-1308
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Country | US
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Telephone | 972-803-4432
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Fax | 833-256-8061
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Provider Business Mailing Address
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Address Line | 6803 HILLCREST AVE STE 208
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City | DALLAS
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State | TX
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Zip | 75205-1308
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Country | US
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Telephone | 972-803-4432
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | DR. EDWARD CHARLES LE CARA
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Credential | DC
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Telephone | 972-803-4432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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