Provider Demographics
NPI:1962647354
Name:BODYTEST
Entity Type:Organization
Organization Name:BODYTEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARS
Authorized Official - Middle Name:
Authorized Official - Last Name:OOMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:281-719-0401
Mailing Address - Street 1:2211 RAYFORD RD
Mailing Address - Street 2:SUITE 111, BOX 131
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1555
Mailing Address - Country:US
Mailing Address - Phone:281-719-0401
Mailing Address - Fax:
Practice Address - Street 1:440 RAYFORD RD
Practice Address - Street 2:SUITE 125
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4168
Practice Address - Country:US
Practice Address - Phone:281-719-0401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDH6938261QP2000X
TX1140655261QP2000X
293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy