Provider Demographics
NPI:1114014792
Name:BODY MECHANIX PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:BODY MECHANIX PHYSICAL THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AGOSTINUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:401-782-4049
Mailing Address - Street 1:163 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3504
Mailing Address - Country:US
Mailing Address - Phone:401-782-4049
Mailing Address - Fax:401-782-0890
Practice Address - Street 1:163 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3504
Practice Address - Country:US
Practice Address - Phone:401-782-4049
Practice Address - Fax:401-782-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI659004397Medicare ID - Type UnspecifiedPHYSICAL THERAPY PRACTICE