Provider Demographics
NPI:1477858884
Name:THE BODY BUILDER, INC.
Entity Type:Organization
Organization Name:THE BODY BUILDER, INC.
Other - Org Name:FREEDOM MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:OVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-688-6555
Mailing Address - Street 1:1121 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-5921
Mailing Address - Country:US
Mailing Address - Phone:620-688-6555
Mailing Address - Fax:620-251-3148
Practice Address - Street 1:1121 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-5921
Practice Address - Country:US
Practice Address - Phone:620-688-6555
Practice Address - Fax:620-251-3148
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE BODY BUILDER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-14
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No171WV0202XOther Service ProvidersContractorVehicle ModificationsGroup - Multi-Specialty