Provider Demographics
NPI:1417319781
Name:BODY MECHANIX
Entity Type:Organization
Organization Name:BODY MECHANIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PT
Authorized Official - Prefix:
Authorized Official - First Name:NICKI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:505-699-5190
Mailing Address - Street 1:530 NW 23RD AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3287
Mailing Address - Country:US
Mailing Address - Phone:505-699-5190
Mailing Address - Fax:
Practice Address - Street 1:530 NW 23RD AVE STE 116
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3287
Practice Address - Country:US
Practice Address - Phone:505-699-5190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5138261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy