Provider Demographics
NPI:1528092442
Name:BODY ONE HEALTH AND FITNESS CENTER, LLC
Entity type:Organization
Organization Name:BODY ONE HEALTH AND FITNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:PEASE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:317-581-1890
Mailing Address - Street 1:8902 N MERIDIAN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5306
Mailing Address - Country:US
Mailing Address - Phone:317-581-1890
Mailing Address - Fax:317-581-2436
Practice Address - Street 1:8902 N MERIDIAN ST
Practice Address - Street 2:STE 215
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5382
Practice Address - Country:US
Practice Address - Phone:317-581-1890
Practice Address - Fax:317-581-2436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002149A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty