Provider Demographics
NPI:1659425809
Name:BODYWISE PHYSICAL THERAPY , LLC
Entity Type:Organization
Organization Name:BODYWISE PHYSICAL THERAPY , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSPT
Authorized Official - Phone:505-983-4882
Mailing Address - Street 1:826 CAMINO DE MONTE REY
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3961
Mailing Address - Country:US
Mailing Address - Phone:505-983-4882
Mailing Address - Fax:505-983-9882
Practice Address - Street 1:826 CAMINO DE MONTE REY
Practice Address - Street 2:SUITE B-3
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3961
Practice Address - Country:US
Practice Address - Phone:505-983-4882
Practice Address - Fax:505-983-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1183225100000X
NM965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty