Provider Demographics
NPI:1003940289
Name:BODYWISE THERAPY PC
Entity Type:Organization
Organization Name:BODYWISE THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-932-8686
Mailing Address - Street 1:PO BOX 27015
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-0015
Mailing Address - Country:US
Mailing Address - Phone:402-393-9459
Mailing Address - Fax:402-397-9895
Practice Address - Street 1:2504 S 119TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2947
Practice Address - Country:US
Practice Address - Phone:402-932-8686
Practice Address - Fax:402-932-8677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0722173Medicaid
NE02013OtherBCBS OF NE
IA0722173Medicaid