Provider Demographics
NPI:1467474353
Name:BODY AND SOUL INC.
Entity Type:Organization
Organization Name:BODY AND SOUL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIETTE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOUIS-CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-782-2250
Mailing Address - Street 1:7810 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2509
Mailing Address - Country:US
Mailing Address - Phone:215-782-2250
Mailing Address - Fax:215-782-2252
Practice Address - Street 1:7810 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2509
Practice Address - Country:US
Practice Address - Phone:215-782-2250
Practice Address - Fax:215-782-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008290L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015389860005Medicaid
PAG17299Medicare UPIN
PA787924Medicare PIN