Provider Demographics
NPI:1285217117
Name:EVOD BODY SOLUTIONS LLC
Entity Type:Organization
Organization Name:EVOD BODY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:484-362-3968
Mailing Address - Street 1:140 POWELL AVE
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-2112
Mailing Address - Country:US
Mailing Address - Phone:484-362-3968
Mailing Address - Fax:
Practice Address - Street 1:140 POWELL AVE
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-2112
Practice Address - Country:US
Practice Address - Phone:484-362-3968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVOD BODY SOLUTIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date: