Provider Demographics
NPI:1154396091
Name:BODYMAX PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:BODYMAX PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMACK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:925-621-2200
Mailing Address - Street 1:6668 OWENS DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3334
Mailing Address - Country:US
Mailing Address - Phone:925-621-2200
Mailing Address - Fax:925-621-2201
Practice Address - Street 1:4165 BLACKHAWK PLAZA CIR
Practice Address - Street 2:#275
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4904
Practice Address - Country:US
Practice Address - Phone:925-736-1305
Practice Address - Fax:925-736-7685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty