Provider Demographics
NPI:1104092840
Name:BODY MECHANIX, LLC
Entity type:Organization
Organization Name:BODY MECHANIX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:NGUYEN
Authorized Official - Last Name:KAMON-BRANCAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:928-680-2639
Mailing Address - Street 1:1695 MESQUITE AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5678
Mailing Address - Country:US
Mailing Address - Phone:928-680-2639
Mailing Address - Fax:928-680-2626
Practice Address - Street 1:1695 MESQUITE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5678
Practice Address - Country:US
Practice Address - Phone:928-680-2639
Practice Address - Fax:928-680-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6192261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy