Provider Demographics
NPI:1457170847
Name:BODYFORGE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:BODYFORGE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PEREZ-ESPINOSA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:786-246-5597
Mailing Address - Street 1:5340 SW 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6360
Mailing Address - Country:US
Mailing Address - Phone:786-246-5597
Mailing Address - Fax:
Practice Address - Street 1:3600 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1030
Practice Address - Country:US
Practice Address - Phone:786-246-5597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty