Healthcare Provider Details

I. General information

NPI: 1467033068
Provider Name (Legal Business Name): BODYWELL PHYSICAL THERAPY AND WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19724 KITTRIDGE ST
WINNETKA CA
91306-4327
US

IV. Provider business mailing address

19724 KITTRIDGE ST
WINNETKA CA
91306-4327
US

V. Phone/Fax

Practice location:
  • Phone: 818-424-2413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEREN PINTO
Title or Position: OWNER/PRESIDENT
Credential: DPT
Phone: 818-424-2413