Organization Name: | BODY RENOVATION HEALTH SERVICES, S.C. |
NPI Number: | 1023210812 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICHARD WAGNER (PRESIDENT) |
Mailing Address: | 2020 Cheyenne Ct Grafton |
State: | WI US |
Postal Code: | 53024 |
Phone Number: | 2623751075 |
Fax Number: | 2623754975 |
NPI Enumeration Date: | 06/04/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |