Provider Demographics
NPI:1568642973
Name:THE BODY CENTER, LLC
Entity Type:Organization
Organization Name:THE BODY CENTER, LLC
Other - Org Name:THE BODY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, PT
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:HARTVIGSEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT, MPT
Authorized Official - Phone:915-269-2135
Mailing Address - Street 1:11440 MONTWOOD DR
Mailing Address - Street 2:BLDG. D
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4374
Mailing Address - Country:US
Mailing Address - Phone:915-356-2639
Mailing Address - Fax:915-356-2642
Practice Address - Street 1:11440 MONTWOOD DR
Practice Address - Street 2:BLDG. D
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4374
Practice Address - Country:US
Practice Address - Phone:915-356-2639
Practice Address - Fax:915-356-2642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1158272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty