Provider Demographics
NPI:1477004190
Name:BODY WISDOM PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BODY WISDOM PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LEDUC
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:775-827-3777
Mailing Address - Street 1:1575 ROBB DR STE 4
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-3526
Mailing Address - Country:US
Mailing Address - Phone:775-827-3777
Mailing Address - Fax:775-827-1013
Practice Address - Street 1:1575 ROBB DR STE 4
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-3526
Practice Address - Country:US
Practice Address - Phone:775-827-3777
Practice Address - Fax:775-827-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1442261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy