Provider Demographics
NPI:1841800869
Name:BODYWISE PURE PILATES, LLC
Entity Type:Organization
Organization Name:BODYWISE PURE PILATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOPATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-796-7870
Mailing Address - Street 1:13 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-2811
Mailing Address - Country:US
Mailing Address - Phone:315-796-7870
Mailing Address - Fax:
Practice Address - Street 1:2615 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6230
Practice Address - Country:US
Practice Address - Phone:315-796-7870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapistGroup - Single Specialty