Provider Demographics
NPI:1881836716
Name:BODYWISE PHYSICAL THERAPY PROFESSIONAL LLC
Entity Type:Organization
Organization Name:BODYWISE PHYSICAL THERAPY PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSEN-HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-444-2529
Mailing Address - Street 1:4440 ARAPAHOE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-9101
Mailing Address - Country:US
Mailing Address - Phone:303-444-2529
Mailing Address - Fax:303-444-2563
Practice Address - Street 1:4440 ARAPAHOE AVE STE 101
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303
Practice Address - Country:US
Practice Address - Phone:303-444-2529
Practice Address - Fax:303-444-2563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty