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NPI Code Detail

MEDICARE: BODY SYSTEMS LIMITED LIABILITY COMPANY

MEDICARE: BODY SYSTEMS LIMITED LIABILITY COMPANY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2000XPhysical Therapy Clinic/Center1191AK

General Provider Information

NPI Number : 1316440100
Entity Type Code : Organization
Provider Name (Legal Business Name) : BODY SYSTEMS LIMITED LIABILITY COMPANY
Provider Business Mailing Address
First Line : 5185 W 80TH AVE
Second Line :
City : ANCHORAGE
State : AK
Zip : 99502-4114
Country : US
Telephone Number : 907-351-2052
Fax Number :
Provider Business Practice Location Address
First Line : 5185 W 80TH AVE
Second Line :
City : ANCHORAGE
State : AK
Zip : 99502-4114
Country : US
Telephone Number : 907-351-2052
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DAVID PAT DISSELBRETT
Credential : MSPT, JSCC
Telephone Number : 907-351-2052
Provider Enumeration Date : 03/17/2018
Last Update Date : 03/17/2018

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Directions to “BODY SYSTEMS LIMITED LIABILITY COMPANY ” Practice Location

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