Provider Demographics
NPI:1285621565
Name:BODIES IN MOTION PHYSICAL THERAPY AND WELLNESS INC.
Entity type:Organization
Organization Name:BODIES IN MOTION PHYSICAL THERAPY AND WELLNESS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:414-482-2469
Mailing Address - Street 1:2499 S DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1941
Mailing Address - Country:US
Mailing Address - Phone:414-482-2469
Mailing Address - Fax:414-482-2748
Practice Address - Street 1:2499 S DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-1941
Practice Address - Country:US
Practice Address - Phone:414-482-2469
Practice Address - Fax:414-747-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4554024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40358400Medicaid
WI40358400Medicaid
WI86644Medicare ID - Type Unspecified