Provider Demographics
NPI:1609279405
Name:ERGO BODY INC.
Entity Type:Organization
Organization Name:ERGO BODY INC.
Other - Org Name:ERGO BODY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-536-1829
Mailing Address - Street 1:3655 SAN JOSE BLVD.
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5224
Mailing Address - Country:US
Mailing Address - Phone:904-536-1829
Mailing Address - Fax:904-396-1787
Practice Address - Street 1:1555 SAN MARCO BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-2905
Practice Address - Country:US
Practice Address - Phone:904-536-1829
Practice Address - Fax:904-396-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19701261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy