Provider Demographics
NPI:1992383467
Name:BODYSOUL COMMUNITY WELLNESS AND PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:BODYSOUL COMMUNITY WELLNESS AND PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TEOMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOEB
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:323-217-4552
Mailing Address - Street 1:3761 HIGH ST # 61-06
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2124
Mailing Address - Country:US
Mailing Address - Phone:323-217-4552
Mailing Address - Fax:
Practice Address - Street 1:3761 HIGH ST # 61-06
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-2124
Practice Address - Country:US
Practice Address - Phone:323-217-4552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty