Provider Demographics
NPI:1558595116
Name:BODY CONNECT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BODY CONNECT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIEKAN
Authorized Official - Middle Name:
Authorized Official - Last Name:UDOFIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:703-209-3359
Mailing Address - Street 1:1600 SOUTH EADS ST.
Mailing Address - Street 2:SUITE 400-S
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202
Mailing Address - Country:US
Mailing Address - Phone:703-209-3359
Mailing Address - Fax:703-664-0735
Practice Address - Street 1:1600 SOUTH EADS ST.
Practice Address - Street 2:SUITE 400S
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202
Practice Address - Country:US
Practice Address - Phone:703-209-3359
Practice Address - Fax:703-664-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty