Provider Demographics
NPI:1619360443
Name:BODYWORKSPT, INC.
Entity Type:Organization
Organization Name:BODYWORKSPT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:DRAGOO
Authorized Official - Last Name:BARANICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:714-724-2575
Mailing Address - Street 1:5122 CASA LOMA AVE
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3943
Mailing Address - Country:US
Mailing Address - Phone:714-724-2575
Mailing Address - Fax:714-993-9878
Practice Address - Street 1:5122 CASA LOMA AVE
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3943
Practice Address - Country:US
Practice Address - Phone:714-724-2575
Practice Address - Fax:714-993-9878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW202342251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty