Provider Demographics
NPI:1215530027
Name:DIVERSE BODY SCULPTURING
Entity type:Organization
Organization Name:DIVERSE BODY SCULPTURING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ BIO MECHANIC SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDUL KARIM
Authorized Official - Suffix:
Authorized Official - Credentials:BMS
Authorized Official - Phone:267-586-9504
Mailing Address - Street 1:7224 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1749
Mailing Address - Country:US
Mailing Address - Phone:267-586-9504
Mailing Address - Fax:
Practice Address - Street 1:7224 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1749
Practice Address - Country:US
Practice Address - Phone:267-586-9504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty