Provider Demographics
NPI:1154809531
Name:BODIES IN MOTION PHYSICAL THERAPY IV, LLC
Entity type:Organization
Organization Name:BODIES IN MOTION PHYSICAL THERAPY IV, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-237-2000
Mailing Address - Street 1:2800 EISENHOWER AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-5204
Mailing Address - Country:US
Mailing Address - Phone:703-237-2000
Mailing Address - Fax:703-237-2155
Practice Address - Street 1:2800 EISENHOWER AVE STE 105
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-5204
Practice Address - Country:US
Practice Address - Phone:703-237-2000
Practice Address - Fax:703-237-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty