Provider Demographics
NPI:1841396033
Name:BODY CONCEPTS INC.
Entity Type:Organization
Organization Name:BODY CONCEPTS INC.
Other - Org Name:BODY CONCEPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:KOPITZKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:916-939-6800
Mailing Address - Street 1:1675 CREEKSIDE DRIVE
Mailing Address - Street 2:STE 101
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3891
Mailing Address - Country:US
Mailing Address - Phone:916-939-6800
Mailing Address - Fax:916-939-6874
Practice Address - Street 1:1675 CREEKSIDE DRIVE
Practice Address - Street 2:STE 101
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3891
Practice Address - Country:US
Practice Address - Phone:916-939-6800
Practice Address - Fax:916-939-6874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CAPT14742261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16328ZMedicare ID - Type Unspecified