Provider Demographics
NPI:1144371915
Name:BODY BY GEOFF
Entity type:Organization
Organization Name:BODY BY GEOFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KIMON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-464-5559
Mailing Address - Street 1:1609 WASHINGTON PLZ N STE B
Mailing Address - Street 2:LAKE ANNE VILLAGE CENTER
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4346
Mailing Address - Country:US
Mailing Address - Phone:703-464-5559
Mailing Address - Fax:703-464-5549
Practice Address - Street 1:1609 WASHINGTON PLZ N STE B
Practice Address - Street 2:LAKE ANNE VILLAGE CENTER
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4346
Practice Address - Country:US
Practice Address - Phone:703-464-5559
Practice Address - Fax:703-464-5549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA239710OtherANTHEM
VAN138OtherCAREFIRST