Provider Demographics
NPI:1093067720
Name:NEOBODY INC
Entity Type:Organization
Organization Name:NEOBODY INC
Other - Org Name:NEOBODY WORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MASSAGE THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AJAYI
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, BP
Authorized Official - Phone:813-473-2744
Mailing Address - Street 1:1435 W BUSCH BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7621
Mailing Address - Country:US
Mailing Address - Phone:813-473-2744
Mailing Address - Fax:813-434-1624
Practice Address - Street 1:1435 W BUSCH BLVD
Practice Address - Street 2:STE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7621
Practice Address - Country:US
Practice Address - Phone:813-473-2744
Practice Address - Fax:813-434-1624
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEOBODY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-04
Last Update Date:2013-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 68053225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06109200Medicaid
FL617186600OtherOFFICE OF WORKERS COMPENSATION
FLMA 68053OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE