MEDICARE: BODY IN MOTION THERAPY, P.C

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
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1932707957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY IN MOTION THERAPY, P.C

Provider Business Mailing Address
First Line	:	1111 S GRAND AVE APT 708
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-2169
Country	:	US
Telephone Number	:	310-439-0633
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 S GRAND AVE APT 708
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-2169
Country	:	US
Telephone Number	:	310-439-0633
Fax Number	:

Authorized Official
Title or Position	:	CEO/OCCUPATIONAL THERAPIST
Name	:	ALI DAKHLALLAH
Credential	:	MOT, OTR/L
Telephone Number	:	310-439-0633

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	10/12/2020

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