Healthcare Provider Details

I. General information

NPI: 1114014792
Provider Name (Legal Business Name): BODY MECHANIX PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 MAIN ST
WAKEFIELD RI
02879-3504
US

IV. Provider business mailing address

163 MAIN ST
WAKEFIELD RI
02879-3504
US

V. Phone/Fax

Practice location:
  • Phone: 401-782-4049
  • Fax: 401-782-0890
Mailing address:
  • Phone: 401-782-4049
  • Fax: 401-782-0890

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: MRS. KAREN ANN AGOSTINUCCI
Title or Position: CLINICAL DIRECTOR
Credential: PT
Phone: 401-782-4049