Provider Demographics
NPI:1750118584
Name:JOBA WELLNESS LLC
Entity type:Organization
Organization Name:JOBA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STUDIO MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONOVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-300-1919
Mailing Address - Street 1:3529 HERITAGE TRACE PKWY STE 111
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4981
Mailing Address - Country:US
Mailing Address - Phone:682-250-3355
Mailing Address - Fax:
Practice Address - Street 1:3529 HERITAGE TRACE PKWY STE 111
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4981
Practice Address - Country:US
Practice Address - Phone:682-250-3355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty