Provider Demographics
NPI:1164439915
Name:BODY AWARENESS PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:BODY AWARENESS PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:714-546-7575
Mailing Address - Street 1:PO BOX 3871
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92628-3871
Mailing Address - Country:US
Mailing Address - Phone:714-546-7575
Mailing Address - Fax:714-546-7573
Practice Address - Street 1:2951 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3912
Practice Address - Country:US
Practice Address - Phone:714-546-7575
Practice Address - Fax:714-546-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15114AMedicare PIN
CAW15114Medicare PIN