Provider Demographics
NPI:1437278744
Name:BODY WORKS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BODY WORKS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHAB SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANITA
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:978-452-6121
Mailing Address - Street 1:103 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1807
Mailing Address - Country:US
Mailing Address - Phone:978-452-6121
Mailing Address - Fax:978-452-8991
Practice Address - Street 1:103 MARKET ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1807
Practice Address - Country:US
Practice Address - Phone:978-452-6121
Practice Address - Fax:978-452-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9786473Medicaid
MA9786473Medicaid