=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437301819
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE BODY WORKS PHYSICAL THERAPY AND WELLNESS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2008
-----------------------------------------------------
Last Update Date | 10/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 217 WESTVIEW PLAZA DR
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62298-1252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-939-7444
-----------------------------------------------------
Fax | 618-939-7448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 217 WESTVIEW PLAZA DR
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62298-1252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-939-7444
-----------------------------------------------------
Fax | 618-939-7448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | MISS JULIE ANNA DOWNS
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 618-939-7444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 2002018374
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 070008988
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------