Provider Demographics
NPI:1588807580
Name:BODYWISE PHYSICAL THERAPY & ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:BODYWISE PHYSICAL THERAPY & ACUPUNCTURE, LLC
Other - Org Name:BODYWISE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARIANNA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:BERKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:240-841-2639
Mailing Address - Street 1:9881 BROKENLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1172
Mailing Address - Country:US
Mailing Address - Phone:240-841-2639
Mailing Address - Fax:240-841-2644
Practice Address - Street 1:9881 BROKENLAND PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1172
Practice Address - Country:US
Practice Address - Phone:240-841-2639
Practice Address - Fax:240-841-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19264261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy