Provider Demographics
NPI:1194904243
Name:BODYBASICS PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:BODYBASICS PHYSICAL THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNSAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:951-736-5646
Mailing Address - Street 1:2275 S MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-5303
Mailing Address - Country:US
Mailing Address - Phone:951-273-7742
Mailing Address - Fax:
Practice Address - Street 1:2275 S MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-5303
Practice Address - Country:US
Practice Address - Phone:951-273-7742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BODYBASICS PHYSICAL THERAPY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-25
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20982261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS81678Medicare UPIN
CA0PT209820Medicare PIN