Provider Demographics
NPI:1255728580
Name:DREAM BODY, INC
Entity type:Organization
Organization Name:DREAM BODY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:CMPT
Authorized Official - Phone:678-908-9220
Mailing Address - Street 1:3812 SEATTLE PL NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 LEGACY PARK BLVD NW
Practice Address - Street 2:D-400
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7412
Practice Address - Country:US
Practice Address - Phone:678-908-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty