Provider Demographics
NPI:1578974960
Name:BODY 4 LIFE
Entity Type:Organization
Organization Name:BODY 4 LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:480-351-0170
Mailing Address - Street 1:8300 N HAYDEN RD
Mailing Address - Street 2:SUITE A203
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2458
Mailing Address - Country:US
Mailing Address - Phone:480-351-1070
Mailing Address - Fax:
Practice Address - Street 1:8300 N HAYDEN RD STE A-203
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2481
Practice Address - Country:US
Practice Address - Phone:480-351-1070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine