Provider Demographics
NPI:1417440025
Name:BODY ENVI WEIGHT LOSS & WELLNESS II
Entity Type:Organization
Organization Name:BODY ENVI WEIGHT LOSS & WELLNESS II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-888-7710
Mailing Address - Street 1:13449 CANOPY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-5915
Mailing Address - Country:US
Mailing Address - Phone:813-888-7710
Mailing Address - Fax:813-908-7711
Practice Address - Street 1:6904 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625
Practice Address - Country:US
Practice Address - Phone:813-888-7710
Practice Address - Fax:813-908-7711
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PMC KNEE PAIN & RESTORATION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-08
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty