Provider Demographics
NPI:1831143031
Name:BODY MECHANIX PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:BODY MECHANIX PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKO
Authorized Official - Suffix:
Authorized Official - Credentials:PT OCS
Authorized Official - Phone:805-584-0001
Mailing Address - Street 1:2585 COCHRAN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2602
Mailing Address - Country:US
Mailing Address - Phone:805-584-0001
Mailing Address - Fax:805-527-9135
Practice Address - Street 1:2585 COCHRAN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2602
Practice Address - Country:US
Practice Address - Phone:805-584-0001
Practice Address - Fax:805-527-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01345ZOtherBLUE SHIELD OF CALIFORNIA
CA377655700OtherU. S. DEPARTMENT OF LABOR
CAZZZ01345ZOtherBLUE SHIELD OF CALIFORNIA
CA377655700OtherU. S. DEPARTMENT OF LABOR