Healthcare Provider Details

I. General information

NPI: 1245850817
Provider Name (Legal Business Name): BODY BE GOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 28TH AVE APT 7
SAN FRANCISCO CA
94121-1874
US

IV. Provider business mailing address

400 28TH AVE APT 7
SAN FRANCISCO CA
94121-1874
US

V. Phone/Fax

Practice location:
  • Phone: 209-769-5548
  • Fax:
Mailing address:
  • Phone: 209-769-5548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS ANDERSON
Title or Position: FOUNDER/OWNER
Credential: PT, DPT
Phone: 209-769-5548