Provider Demographics
NPI:1982122446
Name:INTUITIVE BODY THERAPEUTICS, INC.
Entity Type:Organization
Organization Name:INTUITIVE BODY THERAPEUTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEROCKE
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L, CEAS
Authorized Official - Phone:708-714-1911
Mailing Address - Street 1:8257 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-4329
Mailing Address - Country:US
Mailing Address - Phone:708-714-1911
Mailing Address - Fax:
Practice Address - Street 1:8257 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-4329
Practice Address - Country:US
Practice Address - Phone:708-714-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1215289814OtherPERSONAL