Healthcare Provider Details

I. General information

NPI: 1861691016
Provider Name (Legal Business Name): BODALIA BODY BASICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18601 E SILVERHILL AVE SUITE A
ROBERTSDALE AL
36567-3703
US

IV. Provider business mailing address

18601 E SILVERHILL AVE SUITE A
ROBERTSDALE AL
36567-3703
US

V. Phone/Fax

Practice location:
  • Phone: 251-947-7565
  • Fax: 251-947-2697
Mailing address:
  • Phone: 251-947-7565
  • Fax: 251-947-2697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: NEHAL K BODALIA
Title or Position: PRESIDENT
Credential: BS, CEO
Phone: 251-947-7565