MEDICARE: BIRTHBABYBODY 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1619551199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRTHBABYBODY LLC

Provider Business Mailing Address
First Line	:	9217 W US HIGHWAY 290 STE 150
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-7818
Country	:	US
Telephone Number	:	512-222-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	9217 W US HIGHWAY 290 STE 150
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-7818
Country	:	US
Telephone Number	:	512-222-4222
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHERINE MELOT
Credential	:	DC
Telephone Number	:	512-222-4222

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	05/10/2021

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Directions to “BIRTHBABYBODY LLC ” Practice Location

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