Healthcare Provider Details

I. General information

NPI: 1700271533
Provider Name (Legal Business Name): THATS YOUR BODY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 CABLE ST SUITE A
SAN DIEGO CA
92107-3141
US

IV. Provider business mailing address

4424 HEDIONDA CT
SAN DIEGO CA
92117-3721
US

V. Phone/Fax

Practice location:
  • Phone: 619-808-9219
  • Fax:
Mailing address:
  • Phone: 619-808-9219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: GAL RACHIMI
Title or Position: HHP/OWNER
Credential:
Phone: 619-808-9219