Provider Demographics
NPI:1407100837
Name:BODEVOLVE LLC
Entity Type:Organization
Organization Name:BODEVOLVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-342-0232
Mailing Address - Street 1:1000 N DAVIS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-3202
Mailing Address - Country:US
Mailing Address - Phone:817-342-0232
Mailing Address - Fax:817-275-1401
Practice Address - Street 1:1000 N DAVIS DR
Practice Address - Street 2:SUITE B
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3202
Practice Address - Country:US
Practice Address - Phone:817-342-0232
Practice Address - Fax:817-275-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty