Organization
COLLEYVILLE BODY FOCUS WELLNESS CLINIC, LLC
Active
Organization
COLLEYVILLE BODY FOCUS WELLNESS CLINIC, LLC
Active
Other names
Juvia Med Spa
Organization subpart
No
Provider details
NPI number
Authorized official
CHERI DAVUS (CREDENTIALING MANAGER)
(972) 792-5700
Entity
Organization
Contact information
Practice address
4620 COLLEYVILLE BLVD, STE 102, COLLEYVILLE, TX 76034-3971
(817) 427-3700
Mailing address
9101 LBJ FWY, STE 710, DALLAS, TX 75243-2057
(972) 792-5700
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
N5550
TX
208VP0000X
Pain Medicine Physician
N5550
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N5550
TMB
TX
Enumeration date
12/07/2015
Last updated
12/07/2015
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