Provider Demographics
NPI:1083048409
Name:BODY MECHANICS PHYSICAL THERAPY- HIGH ST PLLC
Entity Type:Organization
Organization Name:BODY MECHANICS PHYSICAL THERAPY- HIGH ST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-282-8485
Mailing Address - Street 1:4127 E PULLMAN RD
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-4007
Mailing Address - Country:US
Mailing Address - Phone:480-282-8485
Mailing Address - Fax:480-323-2777
Practice Address - Street 1:5410 E HIGH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5456
Practice Address - Country:US
Practice Address - Phone:480-282-8485
Practice Address - Fax:480-323-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4369225100000X
AZ10198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty