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General NPI Number Information
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NPI Number | 1225603301
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Entity Type | Organization
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Legal Business Name | BODY EVOLUTION LLC
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 1450 MADRUGA AVE STE 405
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City | CORAL GABLES
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State | FL
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Zip | 33146-3165
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Country | US
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Telephone | 386-747-8634
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Fax |
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Provider Business Mailing Address
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Address Line | 6851 SW 52ND ST
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City | MIAMI
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State | FL
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Zip | 33155-5711
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Country | US
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Telephone | 386-747-8634
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Fax |
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Authorized Official
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Title or Position | AMBR
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Name | DANIELLE DEA
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Credential | DPT
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Telephone | 386-747-8634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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