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General NPI Number Information
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NPI Number | 1437467677
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Entity Type | Organization
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Legal Business Name | BODYWISE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 82 BROAD ST
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City | WESTFIELD
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State | MA
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Zip | 01085-2958
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Country | US
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Telephone | 413-579-2831
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Fax | 888-590-0958
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Provider Business Mailing Address
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Address Line | 47 PLEASANT ST
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City | WESTFIELD
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State | MA
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Zip | 01085-3736
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Country | US
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Telephone | 413-568-4382
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MR. PAUL E WARNER
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Credential | MPT
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Telephone | 413-579-2831
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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 | 17842
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License Number State | MA
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