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General NPI Number Information
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NPI Number | 1154911493
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Entity Type | Organization
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Legal Business Name | BODY WISE PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 01/20/2021
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 2717 W BANNOCK ST STE 101
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City | BOISE
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State | ID
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Zip | 83702-4724
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Country | US
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Telephone | 208-972-0572
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Fax | 208-639-2906
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Provider Business Mailing Address
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Address Line | 2717 W BANNOCK ST STE 101
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City | BOISE
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State | ID
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Zip | 83702-4724
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Country | US
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Telephone | 208-972-0572
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Fax | 208-639-2906
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Authorized Official
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Title or Position | MANAGER/DIRECTOR
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Name | MR. DOUGLAS WINSTON HOGGATT
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Credential | PT
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Telephone | 208-841-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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