Provider Demographics
NPI:1649201682
Name:BODYWELLNESS
Entity type:Organization
Organization Name:BODYWELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-270-7549
Mailing Address - Street 1:2445 WALGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-4134
Mailing Address - Country:US
Mailing Address - Phone:310-270-7549
Mailing Address - Fax:310-822-8026
Practice Address - Street 1:1821 WILSHIRE BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5618
Practice Address - Country:US
Practice Address - Phone:310-453-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298262251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19629Medicare ID - Type UnspecifiedPHYSICAL THERAPY