Basic Information
| Provider Information | |||||||||
| NPI: | 1780899369 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BODYCENTRAL PHYSICAL THERAPY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3124 N SWAN RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857121227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203254002 | ||||||||
| FaxNumber: | 5203254227 | ||||||||
| Practice Location | |||||||||
| Address1: | 3124 N SWAN RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857121227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203254002 | ||||||||
| FaxNumber: | 5203254227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 04/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | ISMAIL | ||||||||
| AuthorizedOfficialFirstName: | BOBBY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2095760888 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
| NPICertificationDate: | 04/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No ID Information.