Provider Demographics
NPI:1891154555
Name:YOUR BODY PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:YOUR BODY PHYSICAL THERAPY, LLC
Other - Org Name:FYZICAL THERAPY AND BALANCE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:LIPANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-286-6068
Mailing Address - Street 1:900 TAMIAMI TRL UNIT 111
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-5513
Mailing Address - Country:US
Mailing Address - Phone:941-286-6068
Mailing Address - Fax:
Practice Address - Street 1:900 TAMIAMI TRL UNIT 111
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5513
Practice Address - Country:US
Practice Address - Phone:941-286-6068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty