1134388903 NPI number — BODY MECHANICS PHYSICAL THERAPY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134388903 NPI number — BODY MECHANICS PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BODY MECHANICS PHYSICAL THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134388903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 DRY MILL RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-737-3697
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 DRY MILL RD SW
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20175-2635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-737-3697
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AYRES
Authorized Official First Name:
KATHARINE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
703-737-3697

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  2305831290 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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