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General NPI Number Information
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NPI Number | 1568117612
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Entity Type | Organization
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Legal Business Name | HEALTHY BODY INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 02/17/2022
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 2400 HIGHWAY 287 N STE 104
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City | MANSFIELD
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State | TX
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Zip | 76063-8872
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Country | US
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Telephone | 817-539-0044
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Fax | 817-539-0682
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Provider Business Mailing Address
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Address Line | 2400 HIGHWAY 287 N STE 104
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City | MANSFIELD
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State | TX
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Zip | 76063-8872
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Country | US
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Telephone | 817-539-0044
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Fax | 817-539-0682
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Authorized Official
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Title or Position | OWNER
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Name | MARCELLE A PETRY
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Credential | DC
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Telephone | 817-539-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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