Provider Demographics
NPI:1104580844
Name:BODYWORX HEALTHPLEX LLC
Entity type:Organization
Organization Name:BODYWORX HEALTHPLEX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COREYON
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-455-7860
Mailing Address - Street 1:PO BOX 9907
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73153-5307
Mailing Address - Country:US
Mailing Address - Phone:469-430-9100
Mailing Address - Fax:
Practice Address - Street 1:14111 KING RD BLDG 4
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-8981
Practice Address - Country:US
Practice Address - Phone:469-430-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty