Healthcare Provider Details

I. General information

NPI: 1104981505
Provider Name (Legal Business Name): BODY WISE THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 HIGHWAY 60
SOCORRO NM
87801
US

IV. Provider business mailing address

PO BOX 342
SOCORRO NM
87801
US

V. Phone/Fax

Practice location:
  • Phone: 505-838-1100
  • Fax: 505-838-0394
Mailing address:
  • Phone: 505-838-1100
  • Fax: 505-838-0394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number007210
License Number StateNM

VIII. Authorized Official

Name: MRS. CHERYL LYNN MURPHY
Title or Position: OWNER MANAGER
Credential:
Phone: 505-838-1100