Provider Demographics
NPI:1962742098
Name:BODY ODYSSEY, INC
Entity type:Organization
Organization Name:BODY ODYSSEY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:LINDY
Authorized Official - Last Name:IRVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT,CBT,APH
Authorized Official - Phone:303-893-2543
Mailing Address - Street 1:1616 WELTON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-4221
Mailing Address - Country:US
Mailing Address - Phone:303-893-2543
Mailing Address - Fax:
Practice Address - Street 1:1616 WELTON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-4221
Practice Address - Country:US
Practice Address - Phone:303-893-2543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4222172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty