Provider Demographics
NPI:1902179484
Name:FUNCTION AT HOME DBA THE BODY MECHANIX
Entity Type:Organization
Organization Name:FUNCTION AT HOME DBA THE BODY MECHANIX
Other - Org Name:THE BODY MECHANIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:FLENTKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-810-0837
Mailing Address - Street 1:18414 NE GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3612
Mailing Address - Country:US
Mailing Address - Phone:503-810-0837
Mailing Address - Fax:
Practice Address - Street 1:18414 NE GARDEN DR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-3612
Practice Address - Country:US
Practice Address - Phone:503-810-0837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA PT 0000 9414261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy