Healthcare Provider Details

I. General information

NPI: 1710364252
Provider Name (Legal Business Name): THE BODY HAUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 E BECK ST REAR
COLUMBUS OH
43206-1207
US

IV. Provider business mailing address

578 S 5TH ST
COLUMBUS OH
43206-1265
US

V. Phone/Fax

Practice location:
  • Phone: 614-832-9783
  • Fax:
Mailing address:
  • Phone: 614-832-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11896
License Number StateOH

VIII. Authorized Official

Name: CRYSTAL SANTIN
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT, DPT, OCS, AT
Phone: 614-832-9783