Provider Demographics
NPI:1144798083
Name:BODY LOUNGE PARK CITIES
Entity Type:Organization
Organization Name:BODY LOUNGE PARK CITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LE CARA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-803-4432
Mailing Address - Street 1:6803 HILLCREST AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1308
Mailing Address - Country:US
Mailing Address - Phone:972-803-4432
Mailing Address - Fax:
Practice Address - Street 1:6803 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-1308
Practice Address - Country:US
Practice Address - Phone:972-803-4432
Practice Address - Fax:833-256-8061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty