Provider Demographics
NPI:1568224152
Name:BODY SOUL WELL
Entity Type:Organization
Organization Name:BODY SOUL WELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOLISTIC HEALTH PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-530-8073
Mailing Address - Street 1:30335 STONEWALL DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-9617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30335 STONEWALL DR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-9617
Practice Address - Country:US
Practice Address - Phone:760-530-8073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty