# 302 BODY SHOP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790468353
- **Authorized official:** RONNIE DIEM PA-C (OWNER)
- **Authorized official phone:** (302) 331-9026

## Contact information

- **Practice address:** 4601 SOUTH DUPONT HIGHWAY, ST 1, DOVER, DE 19901
- **Practice address phone:** (302) 698-1100
- **Mailing address:** 4601 SOUTH DUPONT HIGHWAY, ST 1, DOVER, DE 19901
- **Mailing address phone:** (302) 698-1100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/10/2023
- **Last updated:** 08/10/2023