Provider Demographics
NPI:1255089934
Name:BRAIN & BODY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:BRAIN & BODY PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VEZINA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:313-806-7834
Mailing Address - Street 1:65 S SQUIRREL RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3252
Mailing Address - Country:US
Mailing Address - Phone:248-266-5637
Mailing Address - Fax:
Practice Address - Street 1:65 S SQUIRREL RD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-3252
Practice Address - Country:US
Practice Address - Phone:248-266-5637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-12
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty