Provider Demographics
NPI:1356040497
Name:BODYWORK SCIENCE INSTITUTE
Entity type:Organization
Organization Name:BODYWORK SCIENCE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:ARDALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FASSIH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, LAC
Authorized Official - Phone:610-608-0959
Mailing Address - Street 1:489 DEVON PARK DR STE 315
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1809
Mailing Address - Country:US
Mailing Address - Phone:610-608-0959
Mailing Address - Fax:610-269-4362
Practice Address - Street 1:485 DEVON PARK DR STE 114
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1840
Practice Address - Country:US
Practice Address - Phone:610-608-0959
Practice Address - Fax:610-269-4362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BODYWORK SCIENCE INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1609209907OtherNPPES