Provider Demographics
NPI:1295367084
Name:MY BODY MECHANIC, LLC
Entity Type:Organization
Organization Name:MY BODY MECHANIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CORISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEEFNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:773-458-3835
Mailing Address - Street 1:4007 N KENMORE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2092
Mailing Address - Country:US
Mailing Address - Phone:773-458-3835
Mailing Address - Fax:
Practice Address - Street 1:4007 N KENMORE AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2092
Practice Address - Country:US
Practice Address - Phone:773-458-3835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty