Provider Demographics
NPI:1750994471
Name:THE EDUCATED BODY, LLC
Entity type:Organization
Organization Name:THE EDUCATED BODY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIBBETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD-LMT
Authorized Official - Phone:305-396-1681
Mailing Address - Street 1:3542 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-5716
Mailing Address - Country:US
Mailing Address - Phone:305-396-1861
Mailing Address - Fax:
Practice Address - Street 1:3542 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-5716
Practice Address - Country:US
Practice Address - Phone:305-396-1861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty