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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