Organization
NEW BODY WEIGHT LOSS CENTER LLC
Active
Organization
NEW BODY WEIGHT LOSS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY MODIC (CO OWNER)
(954) 668-6938
Entity
Organization
Contact information
Practice address
518 WASHINGTON ST, JOHNSTOWN, PA 15901-2114
(954) 668-6938
Mailing address
1109 VIRGINIA AVE, JOHNSTOWN, PA 15906-2431
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
06/16/2020
Last updated
06/16/2020
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