Provider Demographics
NPI:1326226374
Name:BODY LOGIC INCORPORATED
Entity Type:Organization
Organization Name:BODY LOGIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHON
Authorized Official - Middle Name:
Authorized Official - Last Name:LORI
Authorized Official - Suffix:
Authorized Official - Credentials:THERAPIST
Authorized Official - Phone:281-229-0698
Mailing Address - Street 1:2109 WILLIAMSBURG CT N
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-5044
Mailing Address - Country:US
Mailing Address - Phone:281-229-0698
Mailing Address - Fax:
Practice Address - Street 1:2109 WILLIAMSBURG CT N
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5044
Practice Address - Country:US
Practice Address - Phone:281-229-0698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-7977-0225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty