Provider Demographics
NPI:1023706298
Name:BODYSET PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:BODYSET PHYSICAL THERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:
Authorized Official - Last Name:RACOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-424-9089
Mailing Address - Street 1:32 PEARSALL AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-3011
Mailing Address - Country:US
Mailing Address - Phone:516-424-9089
Mailing Address - Fax:
Practice Address - Street 1:32 PEARSALL AVE APT 1E
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3011
Practice Address - Country:US
Practice Address - Phone:516-424-9089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty