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General NPI Number Information
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NPI Number | 1003940289
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Entity Type | Organization
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Legal Business Name | BODYWISE THERAPY PC
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 2504 S 119TH ST
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City | OMAHA
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State | NE
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Zip | 68144-2947
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Country | US
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Telephone | 402-932-8686
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Fax | 402-932-8677
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Provider Business Mailing Address
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Address Line | PO BOX 27015
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City | OMAHA
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State | NE
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Zip | 68127-0015
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Country | US
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Telephone | 402-393-9459
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Fax | 402-397-9895
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Authorized Official
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Title or Position | PRESIDENT
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Name | TERESA D MILLER
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Credential | P.T.
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Telephone | 402-932-8686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 257
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License Number State | NE
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