Healthcare Provider Details

I. General information

NPI: 1659564920
Provider Name (Legal Business Name): BODY WORKS STUDIO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 ORANGE ST
NEPTUNE BEACH FL
32266-5125
US

IV. Provider business mailing address

214 ORANGE ST
NEPTUNE BEACH FL
32266-5125
US

V. Phone/Fax

Practice location:
  • Phone: 904-246-4900
  • Fax:
Mailing address:
  • Phone: 904-246-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 12071
License Number StateFL

VIII. Authorized Official

Name: MRS. CYNTHIA BARONI CAREY
Title or Position: PHYSICAL THERAPIST/PRESIDENT
Credential:
Phone: 904-246-4900