Healthcare Provider Details

I. General information

NPI: 1982470522
Provider Name (Legal Business Name): THE BODY OPTIMIZED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 S RAINBOW BLVD STE 151
LAS VEGAS NV
89139-6483
US

IV. Provider business mailing address

7600 S RAINBOW BLVD APT 1091
LAS VEGAS NV
89139-5487
US

V. Phone/Fax

Practice location:
  • Phone: 702-706-3846
  • Fax:
Mailing address:
  • Phone: 815-993-6978
  • 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: DR. ZACHARY ALEXANDER CUPPLES
Title or Position: OWNER
Credential: PT
Phone: 702-706-3846