Provider Demographics
NPI:1912476334
Name:BODYWORKS PROSTHETICS AND ORTHOTICS LLC
Entity Type:Organization
Organization Name:BODYWORKS PROSTHETICS AND ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:CO, BOCP
Authorized Official - Phone:307-578-8820
Mailing Address - Street 1:720 LINDSAY LN STE B2
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-4143
Mailing Address - Country:US
Mailing Address - Phone:307-578-8820
Mailing Address - Fax:307-578-8828
Practice Address - Street 1:720 LINDSAY LN STE B2
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4143
Practice Address - Country:US
Practice Address - Phone:307-578-8820
Practice Address - Fax:307-578-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier