Provider Demographics
NPI:1598541625
Name:BODY LOUNGE HTX LLC
Entity Type:Organization
Organization Name:BODY LOUNGE HTX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRAY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:832-340-8276
Mailing Address - Street 1:2616 S LOOP W STE 655
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2790
Mailing Address - Country:US
Mailing Address - Phone:832-509-1553
Mailing Address - Fax:
Practice Address - Street 1:2616 S LOOP W STE 655
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2790
Practice Address - Country:US
Practice Address - Phone:832-509-1553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BODY LOUNGE HTX LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty