Provider Demographics
NPI:1043272669
Name:BODY GARAGE INC.
Entity Type:Organization
Organization Name:BODY GARAGE INC.
Other - Org Name:OJAI VALLEY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:KOTULA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:805-646-4906
Mailing Address - Street 1:407 W OJAI AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2443
Mailing Address - Country:US
Mailing Address - Phone:805-646-4906
Mailing Address - Fax:805-624-5987
Practice Address - Street 1:407 W OJAI AVE
Practice Address - Street 2:SUITE C
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023
Practice Address - Country:US
Practice Address - Phone:805-646-4906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ63156Medicare UPIN
CAW19568Medicare ID - Type UnspecifiedGROUP NUMBER
CAWPT29769AMedicare ID - Type UnspecifiedPPIN FOR ANNA KOTULA, DPT