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General NPI Number Information
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NPI Number | 1851003214
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Entity Type | Organization
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Legal Business Name | BODYWAVEZ FITNESS
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Dates
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Enumeration Date | 12/16/2022
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Last Update Date | 12/16/2022
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Provider Practice Location Address
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Address Line | 919 FLORIDA AVE NW APT 602
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City | WASHINGTON
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State | DC
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Zip | 20001-5048
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Country | US
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Telephone | 734-329-3230
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Fax |
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Provider Business Mailing Address
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Address Line | 5214 TROTTERS GLEN DR
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City | UPPR MARLBORO
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State | MD
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Zip | 20772-2903
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. RACHEL WINSTON
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Credential |
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Telephone | 734-329-3230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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