Organization
IDEAL BODY WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL A MAHONEY (CEO)
(703) 856-6803
Entity
Organization
Contact information
Practice address
8206 LEESBURG PIKE STE 302, VIENNA, VA 22182-2614
(703) 856-6803
Mailing address
10348 BRITTENFORD DR, VIENNA, VA 22182-1860
(703) 856-6803
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
Other
Enumeration date
05/21/2013
Last updated
05/21/2013
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