Provider Demographics
NPI:1992353668
Name:BODYWORKS PHYSICAL THERAPY ORTHOPEDIC AND SPORTS REHAB
Entity type:Organization
Organization Name:BODYWORKS PHYSICAL THERAPY ORTHOPEDIC AND SPORTS REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-884-1865
Mailing Address - Street 1:3051 SOUTH 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4609
Mailing Address - Country:US
Mailing Address - Phone:541-884-1865
Mailing Address - Fax:541-884-1455
Practice Address - Street 1:3051 SOUTH 6TH STREET
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4609
Practice Address - Country:US
Practice Address - Phone:541-884-1865
Practice Address - Fax:541-884-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty