Provider Demographics
NPI:1366851966
Name:BODY LOGIC PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BODY LOGIC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:BROCK
Authorized Official - Last Name:HIGGINBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:334-380-5920
Mailing Address - Street 1:PO BOX 242817
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-2817
Mailing Address - Country:US
Mailing Address - Phone:334-380-5920
Mailing Address - Fax:334-380-5921
Practice Address - Street 1:7150 HALCYON PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7713
Practice Address - Country:US
Practice Address - Phone:334-380-5920
Practice Address - Fax:334-380-5921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty