Provider Demographics
NPI:1467175075
Name:BODY SENSE THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:BODY SENSE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GYR
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:720-626-1083
Mailing Address - Street 1:11874 S LAKE ST
Mailing Address - Street 2:
Mailing Address - City:EMPIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49630-9409
Mailing Address - Country:US
Mailing Address - Phone:720-626-1083
Mailing Address - Fax:
Practice Address - Street 1:11874 S LAKE ST
Practice Address - Street 2:
Practice Address - City:EMPIRE
Practice Address - State:MI
Practice Address - Zip Code:49630-9409
Practice Address - Country:US
Practice Address - Phone:720-626-1083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1891289799Medicaid