Provider Demographics
NPI:1770446841
Name:BODY VITALITY LLC
Entity type:Organization
Organization Name:BODY VITALITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:602-824-8466
Mailing Address - Street 1:2174 E WILLIAMS FIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0160
Mailing Address - Country:US
Mailing Address - Phone:602-824-8466
Mailing Address - Fax:833-973-5655
Practice Address - Street 1:2174 E WILLIAMS FIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0160
Practice Address - Country:US
Practice Address - Phone:602-824-8466
Practice Address - Fax:833-973-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-05
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty