Healthcare Provider Details

I. General information

NPI: 1154399467
Provider Name (Legal Business Name): BODYSCAPE INTEGRATIVE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3018 E COLORADO BLVD STE 100
PASADENA CA
91107-3840
US

IV. Provider business mailing address

3018 E COLORADO BLVD STE 100
PASADENA CA
91107-3840
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-3900
  • Fax: 626-449-4505
Mailing address:
  • Phone: 626-449-3900
  • Fax: 626-449-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT27660
License Number StateCA

VIII. Authorized Official

Name: LESLIE ELLEN FRANK
Title or Position: PRESIDENT
Credential: DPT
Phone: 626-449-3900