Provider Demographics
NPI:1669648481
Name:EMBODY YOGA & PHYSICAL THERAPY CENTERS INC
Entity Type:Organization
Organization Name:EMBODY YOGA & PHYSICAL THERAPY CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:858-454-9355
Mailing Address - Street 1:5632 LA JOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-454-9355
Mailing Address - Fax:858-454-9305
Practice Address - Street 1:5632 LA JOLLA BLVD
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-454-9355
Practice Address - Fax:858-454-9305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMBODY YOGA & PHYSICAL THERAPY CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13530225100000X
CAPT23105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty