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General NPI Number Information
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NPI Number | 1356587919
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Entity Type | Organization
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Legal Business Name | BODY FIRM, INC
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Dates
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Enumeration Date | 12/31/2008
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Last Update Date | 03/02/2010
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Provider Practice Location Address
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Address Line | 8283 N OWASSO EXPY
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City | OWASSO
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State | OK
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Zip | 74055-3634
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Country | US
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Telephone | 918-272-3002
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Fax | 918-272-3048
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Provider Business Mailing Address
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Address Line | 8283 N OWASSO EXPY
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City | OWASSO
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State | OK
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Zip | 74055-3634
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Country | US
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Telephone | 918-272-3002
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Fax | 918-272-3048
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Authorized Official
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Title or Position | VP
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Name | KELLY JOHNSON
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Credential | PT
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Telephone | 918-272-3002
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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 | 4130
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License Number State | OK
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