Provider Demographics
NPI:1154911493
Name:BODY WISE PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:BODY WISE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:WINSTON
Authorized Official - Last Name:HOGGATT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-841-9900
Mailing Address - Street 1:2717 W BANNOCK ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4724
Mailing Address - Country:US
Mailing Address - Phone:208-972-0572
Mailing Address - Fax:208-639-2906
Practice Address - Street 1:2717 W BANNOCK ST STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4724
Practice Address - Country:US
Practice Address - Phone:208-972-0572
Practice Address - Fax:208-639-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy