Provider Demographics
NPI:1699306407
Name:BODY AND MIND PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:BODY AND MIND PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAEIDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:BADIEFARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-295-6187
Mailing Address - Street 1:1125 E 17TH ST STE W237
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2205
Mailing Address - Country:US
Mailing Address - Phone:908-295-6187
Mailing Address - Fax:
Practice Address - Street 1:1125 E 17TH ST STE W237
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2205
Practice Address - Country:US
Practice Address - Phone:714-760-4577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy