Provider Demographics
NPI:1609884279
Name:BODY WELL LLC
Entity Type:Organization
Organization Name:BODY WELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MELMED
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:954-496-2503
Mailing Address - Street 1:2787 E OAKLAND PARK BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1647
Mailing Address - Country:US
Mailing Address - Phone:954-784-2076
Mailing Address - Fax:
Practice Address - Street 1:2787 E OAKLAND PARK BLVD
Practice Address - Street 2:STE 204
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1647
Practice Address - Country:US
Practice Address - Phone:954-496-2503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 44521251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health