Provider Demographics
NPI:1285225540
Name:MIND BODY PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MIND BODY PHYSICAL THERAPY PC
Other - Org Name:MIND BODY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:CHANDRA
Authorized Official - Last Name:FROHLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-362-1196
Mailing Address - Street 1:PO BOX 10785
Mailing Address - Street 2:
Mailing Address - City:ZEPHYR COVE
Mailing Address - State:NV
Mailing Address - Zip Code:89448-2785
Mailing Address - Country:US
Mailing Address - Phone:530-541-7133
Mailing Address - Fax:530-725-4500
Practice Address - Street 1:212 ELKS POINT RD UNIT 332
Practice Address - Street 2:
Practice Address - City:ZEPHYR COVE
Practice Address - State:NV
Practice Address - Zip Code:89448-8016
Practice Address - Country:US
Practice Address - Phone:530-541-7133
Practice Address - Fax:530-725-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2024-04-10
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
14128397OtherCAQH