Provider Demographics
NPI:1205373628
Name:BODY BY PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:BODY BY PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TARO
Authorized Official - Middle Name:
Authorized Official - Last Name:WICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MTC
Authorized Official - Phone:832-620-1225
Mailing Address - Street 1:PO BOX 770211
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77215-0211
Mailing Address - Country:US
Mailing Address - Phone:832-620-1225
Mailing Address - Fax:
Practice Address - Street 1:7777 SOUTHWEST FWY
Practice Address - Street 2:SUITE #640
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1802
Practice Address - Country:US
Practice Address - Phone:713-270-0477
Practice Address - Fax:713-270-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1272156261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy