Provider Demographics
NPI:1699460329
Name:BODY REHAB & PERFORMANCE LLC
Entity type:Organization
Organization Name:BODY REHAB & PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:ASBATE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:321-436-1095
Mailing Address - Street 1:723 N BAY ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-2939
Mailing Address - Country:US
Mailing Address - Phone:321-436-1095
Mailing Address - Fax:
Practice Address - Street 1:723 N BAY ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-2939
Practice Address - Country:US
Practice Address - Phone:321-436-1095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty