Provider Demographics
NPI:1255635611
Name:BODY BEAUTIFUL AEROBIC AND FITNESS CENTER
Entity type:Organization
Organization Name:BODY BEAUTIFUL AEROBIC AND FITNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:504-274-7537
Mailing Address - Street 1:10709 CHEF MENTEUR HWY STE 2
Mailing Address - Street 2:NEW ORLEANS
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-4262
Mailing Address - Country:US
Mailing Address - Phone:504-274-7537
Mailing Address - Fax:504-281-4921
Practice Address - Street 1:10709 CHEF MENTEUR HWY STE 2
Practice Address - Street 2:NEW ORLEANS
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-4262
Practice Address - Country:US
Practice Address - Phone:504-274-7537
Practice Address - Fax:504-281-4921
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHP HEALTHCARE SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-28
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA102800826302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization