Provider Demographics
NPI:1225603301
Name:BODY EVOLUTION LLC
Entity Type:Organization
Organization Name:BODY EVOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:386-747-8634
Mailing Address - Street 1:6851 SW 52ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5711
Mailing Address - Country:US
Mailing Address - Phone:386-747-8634
Mailing Address - Fax:
Practice Address - Street 1:1450 MADRUGA AVE STE 405
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3165
Practice Address - Country:US
Practice Address - Phone:386-747-8634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy