Provider Demographics
NPI:1437467677
Name:BODYWISE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BODYWISE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:413-579-2831
Mailing Address - Street 1:47 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-3736
Mailing Address - Country:US
Mailing Address - Phone:413-568-4382
Mailing Address - Fax:
Practice Address - Street 1:82 BROAD ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-2958
Practice Address - Country:US
Practice Address - Phone:413-579-2831
Practice Address - Fax:888-590-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty