MEDICARE: BODYWINS 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1306443320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODYWINS LLC

Provider Business Mailing Address
First Line	:	2930 NW 26TH AVE
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33434-3664
Country	:	US
Telephone Number	:	954-667-7908
Fax Number	:

Provider Business Practice Location Address
First Line	:	3221 NW 10TH TER STE 508
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-5942
Country	:	US
Telephone Number	:	954-667-7908
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT & CHIEF OF STAFF
Name	:	MARIA ELISE LASSO
Credential	:	JD
Telephone Number	:	954-951-1539

Provider Enumeration Date	:	10/02/2020
Last Update Date	:	04/30/2021

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Directions to “BODYWINS LLC ” Practice Location

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