Provider Demographics
NPI:1295029494
Name:BODYWORK FOR WELLNESS MANUAL PHYSICAL THERAPY&THERAPEUTIC MASSAGE PLLC
Entity Type:Organization
Organization Name:BODYWORK FOR WELLNESS MANUAL PHYSICAL THERAPY&THERAPEUTIC MASSAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CATINO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:518-424-6487
Mailing Address - Street 1:350 NORTHERN BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1000
Mailing Address - Country:US
Mailing Address - Phone:518-424-6487
Mailing Address - Fax:518-463-3020
Practice Address - Street 1:350 NORTHERN BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1000
Practice Address - Country:US
Practice Address - Phone:518-424-6487
Practice Address - Fax:518-463-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023932-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty