Provider Demographics
NPI:1427822790
Name:BOD SHOP PHYSICAL THERAPY & FITNESS LLC
Entity type:Organization
Organization Name:BOD SHOP PHYSICAL THERAPY & FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:215-622-4862
Mailing Address - Street 1:169 W DURHAM ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2433
Mailing Address - Country:US
Mailing Address - Phone:215-622-4862
Mailing Address - Fax:
Practice Address - Street 1:169 W DURHAM ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2433
Practice Address - Country:US
Practice Address - Phone:215-622-4862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty