Provider Demographics
NPI:1982470522
Name:THE BODY OPTIMIZED, LLC
Entity Type:Organization
Organization Name:THE BODY OPTIMIZED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:CUPPLES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:702-706-3846
Mailing Address - Street 1:7600 S RAINBOW BLVD APT 1091
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-5487
Mailing Address - Country:US
Mailing Address - Phone:815-993-6978
Mailing Address - Fax:
Practice Address - Street 1:5959 S VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3111
Practice Address - Country:US
Practice Address - Phone:702-706-3846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy