Healthcare Provider Details

I. General information

NPI: 1609120245
Provider Name (Legal Business Name): BODY HOLISTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10707 66TH ST N SUITE F
PINELLAS PARK FL
33782-2352
US

IV. Provider business mailing address

10707 66TH ST N SUITE F
PINELLAS PARK FL
33782-2352
US

V. Phone/Fax

Practice location:
  • Phone: 727-329-8698
  • Fax: 727-329-8698
Mailing address:
  • Phone: 727-329-8698
  • Fax: 727-329-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberMA#64262
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberOT#13546
License Number StateFL

VIII. Authorized Official

Name: MS. RUTH ADELE COOPEE
Title or Position: OWNER
Credential: OTR/L, CLT, LMT
Phone: 727-329-8698