MEDICARE: MY BODYWORX WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1053996165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY BODYWORX WELLNESS LLC

Provider Business Mailing Address
First Line	:	14560 S MILITARY TRL STE B4
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-3794
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14560 S MILITARY TRL STE B4
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-3794
Country	:	US
Telephone Number	:	561-926-9494
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JON SEGAL
Credential	:	DC
Telephone Number	:	561-926-9494

Provider Enumeration Date	:	03/10/2021
Last Update Date	:	04/16/2025

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