Provider Demographics
NPI:1154399467
Name:BODYSCAPE INTEGRATIVE PHYSICAL THERAPY
Entity type:Organization
Organization Name:BODYSCAPE INTEGRATIVE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:626-449-3900
Mailing Address - Street 1:3018 E COLORADO BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3840
Mailing Address - Country:US
Mailing Address - Phone:626-449-3900
Mailing Address - Fax:626-449-4505
Practice Address - Street 1:3018 E COLORADO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3840
Practice Address - Country:US
Practice Address - Phone:626-449-3900
Practice Address - Fax:626-449-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05566ZOtherBLUE SHIELD