Healthcare Provider Details

I. General information

NPI: 1386721850
Provider Name (Legal Business Name): BODY DYNAMICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 CANYON BLVD SUITE A-4
BOULDER CO
80302-6748
US

IV. Provider business mailing address

2660 CANYON BLVD SUITE A-4
BOULDER CO
80302-6748
US

V. Phone/Fax

Practice location:
  • Phone: 303-440-5776
  • Fax: 303-546-0020
Mailing address:
  • Phone: 303-440-5776
  • Fax: 303-546-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. LINDSAY ROSS
Title or Position: CO-OWNER
Credential:
Phone: 303-440-5776