Provider Demographics
NPI:1609120245
Name:BODY HOLISTICS INC
Entity Type:Organization
Organization Name:BODY HOLISTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ADELE
Authorized Official - Last Name:COOPEE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CLT, LMT
Authorized Official - Phone:727-329-8698
Mailing Address - Street 1:10707 66TH ST N
Mailing Address - Street 2:SUITE F
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-2352
Mailing Address - Country:US
Mailing Address - Phone:727-329-8698
Mailing Address - Fax:727-329-8698
Practice Address - Street 1:10707 66TH ST N
Practice Address - Street 2:SUITE F
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-2352
Practice Address - Country:US
Practice Address - Phone:727-329-8698
Practice Address - Fax:727-329-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT#13546261QP2000X
FLMA#64262261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427123827Medicare PIN