Provider Demographics
NPI:1962110734
Name:REDEMPTION BODY WELLNESS LLC
Entity type:Organization
Organization Name:REDEMPTION BODY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:267-968-9250
Mailing Address - Street 1:882 N LEX ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-1353
Mailing Address - Country:US
Mailing Address - Phone:267-438-1994
Mailing Address - Fax:
Practice Address - Street 1:882 N LEX ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1353
Practice Address - Country:US
Practice Address - Phone:267-438-1994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Single Specialty
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
No332U00000XSuppliersHome Delivered MealsGroup - Single Specialty