Provider Demographics
NPI:1487419958
Name:SMART BODY LLC
Entity type:Organization
Organization Name:SMART BODY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-884-5401
Mailing Address - Street 1:809 WOODBRIDGE PKWY STE 500-317
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7148
Mailing Address - Country:US
Mailing Address - Phone:918-884-5401
Mailing Address - Fax:
Practice Address - Street 1:809 WOODBRIDGE PKWY STE 500-317
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7148
Practice Address - Country:US
Practice Address - Phone:918-884-5401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Single Specialty