Provider Demographics
NPI:1083673891
Name:BODYWISE PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:BODYWISE PHYSICAL THERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:212-517-0020
Mailing Address - Street 1:148 E 84TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2095
Mailing Address - Country:US
Mailing Address - Phone:212-517-0020
Mailing Address - Fax:212-517-4526
Practice Address - Street 1:148 E 84TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2047
Practice Address - Country:US
Practice Address - Phone:212-517-0020
Practice Address - Fax:212-517-4526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQAW751Medicare ID - Type Unspecified