Provider Demographics
NPI:1669172193
Name:EMBODY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:EMBODY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PRINCIC
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-410-4716
Mailing Address - Street 1:3727 E ASTER DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7328
Mailing Address - Country:US
Mailing Address - Phone:602-410-4716
Mailing Address - Fax:
Practice Address - Street 1:3727 E ASTER DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7328
Practice Address - Country:US
Practice Address - Phone:602-410-4716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No251E00000XAgenciesHome Health