Provider Demographics
NPI:1316440100
Name:BODY SYSTEMS LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:BODY SYSTEMS LIMITED LIABILITY COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAT
Authorized Official - Last Name:DISSELBRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, JSCC
Authorized Official - Phone:907-351-2052
Mailing Address - Street 1:5185 W 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-4114
Mailing Address - Country:US
Mailing Address - Phone:907-351-2052
Mailing Address - Fax:
Practice Address - Street 1:5185 W 80TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-4114
Practice Address - Country:US
Practice Address - Phone:907-351-2052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1191261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy