Provider Demographics
NPI:1689085177
Name:BODY WORKS PHYSICAL THERAPY, LTD.
Entity Type:Organization
Organization Name:BODY WORKS PHYSICAL THERAPY, LTD.
Other - Org Name:BLISS MASSAGE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-893-2639
Mailing Address - Street 1:3161 43RD ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8791
Mailing Address - Country:US
Mailing Address - Phone:701-893-2639
Mailing Address - Fax:701-893-2638
Practice Address - Street 1:3161 43RD ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8791
Practice Address - Country:US
Practice Address - Phone:701-893-2639
Practice Address - Fax:701-893-2638
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BODY WORKS PHYSICAL THERAPY, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-19
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND961225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty