Healthcare Provider Details

I. General information

NPI: 1083614473
Provider Name (Legal Business Name): BODYWORKS PHYSICAL THERAPY AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12211 KAIN RD
GLEN ALLEN VA
23059-5720
US

IV. Provider business mailing address

12211 KAIN RD
GLEN ALLEN VA
23059-5720
US

V. Phone/Fax

Practice location:
  • Phone: 804-519-8751
  • Fax: 804-364-3567
Mailing address:
  • Phone: 804-519-8751
  • Fax: 804-364-3567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2305006683
License Number StateVA

VIII. Authorized Official

Name: MR. ERIK MATTHEW SANDVIG
Title or Position: PRESIDENT/ PHYSICAL THERAPIST
Credential: MS, MPT
Phone: 804-519-8751