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General NPI Number Information
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NPI Number | 1083090252
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Entity Type | Organization
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Legal Business Name | BODY WORKS PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 08/10/2015
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Last Update Date | 08/14/2020
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Provider Practice Location Address
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Address Line | 4080 LOMA VISTA RD SUITE H
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City | VENTURA
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State | CA
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Zip | 93003
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Country | US
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Telephone | 805-535-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 4080 LOMA VISTA RD STE H
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City | VENTURA
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State | CA
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Zip | 93003-1811
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Country | US
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Telephone | 805-804-7367
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | JEFF WILSON
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Credential | MPT
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Telephone | 805-535-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT21563
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License Number State | CA
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