1669875415 NPI number — BODY WERKS PHYSICAL THERAPY PLLC

Table of content: MS. DENISE G. MENAPACE CRNP (NPI 1447213087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669875415 NPI number — BODY WERKS PHYSICAL THERAPY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BODY WERKS PHYSICAL THERAPY PLLC
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:
1669875415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
183 E MAIN ST STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDONIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14063-1435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-680-8180
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
183 E MAIN ST STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDONIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14063-1435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-680-8180
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MANDELL
Authorized Official First Name:
JOLIE
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
PT
Authorized Official Telephone Number:
716-680-8180

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  021033 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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