Provider Demographics
NPI:1013581735
Name:BODY REHAB LLC
Entity Type:Organization
Organization Name:BODY REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ELODIE
Authorized Official - Last Name:DEMARSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-410-1030
Mailing Address - Street 1:1725 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6507
Mailing Address - Country:US
Mailing Address - Phone:239-410-1030
Mailing Address - Fax:
Practice Address - Street 1:1725 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6507
Practice Address - Country:US
Practice Address - Phone:239-410-1030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy