Healthcare Provider Details

I. General information

NPI: 1073013397
Provider Name (Legal Business Name): BODY MECHANICS PHYSICAL THERAPY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 E HIBISCUS BLVD
MELBOURNE FL
32901-3219
US

IV. Provider business mailing address

440 ORIOLE LN
INDIALANTIC FL
32903-4736
US

V. Phone/Fax

Practice location:
  • Phone: 321-482-4096
  • Fax:
Mailing address:
  • Phone: 321-482-4096
  • 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: JANELLE BIELE
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 321-482-4096