Provider Demographics
NPI:1083614473
Name:BODYWORKS PHYSICAL THERAPY AND REHABILITATION
Entity Type:Organization
Organization Name:BODYWORKS PHYSICAL THERAPY AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:SANDVIG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MPT
Authorized Official - Phone:804-519-8751
Mailing Address - Street 1:12211 KAIN RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5720
Mailing Address - Country:US
Mailing Address - Phone:804-519-8751
Mailing Address - Fax:804-364-3567
Practice Address - Street 1:12211 KAIN RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5720
Practice Address - Country:US
Practice Address - Phone:804-519-8751
Practice Address - Fax:804-364-3567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X
VA2305006683251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty