Organization Name: | BODY MECHANIX, LLC |
NPI Number: | 1104092840 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMIE NGUYEN KAMON-BRANCAZIO (OWNER/PRESIDENT) |
Mailing Address: | 1695 Mesquite Ave Suite 106 Lake Havasu City |
State: | AZ US |
Postal Code: | 864035678 |
Phone Number: | 9286802639 |
Fax Number: | 9286802626 |
NPI Enumeration Date: | 05/02/2008 |
NPI Last Update Date: | 07/01/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | 6192 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |