Organization · NPI-2
Prodigy Yoga
Clinic/Center · Texarkana, AR
NPI number1861173874
StatusActive
Last updated in NPPESJul 31, 2023
Details
- NPI
- 1861173874
- Entity type
- Organization (NPI-2)
- Legal business name
- Prodigy Yoga
- Organization subpart
- No
- Enumeration date
- Jul 31, 2023
- Certification date
- Jul 31, 2023
- Last updated
- Jul 31, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
Other names
- Prodigy Wellness Collective (Doing Business As)
- Prodigy Life (Other Name)
Practice location
200 E Broad StTexarkana, AR 71854-5904
Phone 210-860-3493
Mailing address
7 Carol LnTexarkana, TX 75501-9700
Phone 210-860-3493
Other practice locations
3423 New Boston Rd
Texarkana, TX 75501-3137
Texarkana, TX 75501-3137
Phone 210-860-3493
Authorized official
Jessica Renee Mccarty
Owner, Yoga Therapist
2108603493
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