Provider Demographics
NPI:1992380885
Name:SAMADHI BODYWORK CORPORATION
Entity Type:Organization
Organization Name:SAMADHI BODYWORK CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-488-1830
Mailing Address - Street 1:374 SW 16TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6627
Mailing Address - Country:US
Mailing Address - Phone:786-488-1830
Mailing Address - Fax:
Practice Address - Street 1:11045 SW 216 STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170
Practice Address - Country:US
Practice Address - Phone:786-488-1830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty