Provider Demographics
NPI:1033623673
Name:BODY G O A L S PHYSICAL THERAPY & WELLNESS
Entity Type:Organization
Organization Name:BODY G O A L S PHYSICAL THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER/DPT
Authorized Official - Prefix:
Authorized Official - First Name:QUIANA
Authorized Official - Middle Name:T
Authorized Official - Last Name:FLUELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, CERT DN
Authorized Official - Phone:678-298-9484
Mailing Address - Street 1:875 OLD ROSWELL RD STE F100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1658
Mailing Address - Country:US
Mailing Address - Phone:678-871-6827
Mailing Address - Fax:
Practice Address - Street 1:875 OLD ROSWELL RD STE F100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1658
Practice Address - Country:US
Practice Address - Phone:678-871-6827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy