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General NPI Number Information
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NPI Number | 1235909185
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Entity Type | Organization
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Legal Business Name | BODY SPIRIT & SOUL MEDICAL PLLC
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 01/07/2024
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Provider Practice Location Address
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Address Line | 7165 COLLEYVILLE BLVD STE 102
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City | COLLEYVILLE
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State | TX
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Zip | 76034-8010
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Country | US
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Telephone | 972-983-8915
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Fax | 949-695-3905
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Provider Business Mailing Address
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Address Line | 1611 PHEASANT LN
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City | SOUTHLAKE
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State | TX
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Zip | 76092-3436
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Country | US
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Telephone | 972-983-8915
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN / OWNER
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Name | DR. JOSEPH B VENTIMIGLIA
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Credential | MD
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Telephone | 972-983-8915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | NULL
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