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General NPI Number Information
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NPI Number | 1417319781
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Entity Type | Organization
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Legal Business Name | BODY MECHANIX
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 530 NW 23RD AVE STE 116
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City | PORTLAND
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State | OR
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Zip | 97210-3287
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Country | US
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Telephone | 505-699-5190
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Fax |
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Provider Business Mailing Address
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Address Line | 530 NW 23RD AVE STE 116
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City | PORTLAND
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State | OR
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Zip | 97210-3287
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Country | US
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Telephone | 505-699-5190
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Fax |
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Authorized Official
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Title or Position | LEAD PT
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Name | NICKI MARIE MCDANIEL
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Credential | MPT
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Telephone | 505-699-5190
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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 | 5138
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License Number State | OR
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