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General NPI Number Information
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NPI Number | 1750118584
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Entity Type | Organization
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Legal Business Name | JOBA WELLNESS LLC
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Dates
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Enumeration Date | 09/16/2024
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 3529 HERITAGE TRACE PKWY STE 111
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City | FORT WORTH
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State | TX
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Zip | 76244-4981
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Country | US
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Telephone | 682-250-3355
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Fax |
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Provider Business Mailing Address
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Address Line | 3529 HERITAGE TRACE PKWY STE 111
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City | FORT WORTH
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State | TX
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Zip | 76244-4981
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Country | US
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Telephone | 682-250-3355
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Fax |
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Authorized Official
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Title or Position | STUDIO MANAGER
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Name | MR. DONOVAN ROA
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Credential |
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Telephone | 281-300-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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