Provider Demographics
NPI:1710597505
Name:7FOLDS BODY AND WELLNESS LLC
Entity Type:Organization
Organization Name:7FOLDS BODY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-692-2869
Mailing Address - Street 1:1848 WESTERN CENTER BLVD APT 628
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-2263
Mailing Address - Country:US
Mailing Address - Phone:818-692-2869
Mailing Address - Fax:817-952-7072
Practice Address - Street 1:1912 CENTRAL DR STE J
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5894
Practice Address - Country:US
Practice Address - Phone:817-692-2869
Practice Address - Fax:817-952-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1720629033Medicaid