Provider Demographics
NPI:1982837647
Name:OPTIMAL WELLNESS & BODY SCULPTING INC.
Entity Type:Organization
Organization Name:OPTIMAL WELLNESS & BODY SCULPTING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHABLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-238-5751
Mailing Address - Street 1:915 BAINBRIDGE ST
Mailing Address - Street 2:#102
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1947
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 WALNUT ST
Practice Address - Street 2:LL30
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3323
Practice Address - Country:US
Practice Address - Phone:215-238-5751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty