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General NPI Number Information
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NPI Number | 1982419461
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Entity Type | Organization
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Legal Business Name | BODY DOJO LLC
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 8958 HILL DR
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City | IRWIN
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State | PA
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Zip | 15642-3112
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Country | US
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Telephone | 724-755-3020
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Fax |
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Provider Business Mailing Address
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Address Line | 1059 GIULIA DR
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City | IRWIN
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State | PA
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Zip | 15642-4187
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Country | US
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Telephone | 412-722-3618
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Fax |
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Authorized Official
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Title or Position | FOUNDING PARTNER
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Name | COREY DEASY
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Credential |
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Telephone | 412-722-3618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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