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General NPI Number Information
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NPI Number | 1538524020
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Entity Type | Organization
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Legal Business Name | BODY MECHANIX, INC.
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Dates
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Enumeration Date | 12/28/2015
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Last Update Date | 12/28/2015
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Provider Practice Location Address
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Address Line | 5125 CHESTNUT KNOLL LN
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City | CHARLOTTE
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State | NC
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Zip | 28269-8241
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Country | US
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Telephone | 704-596-6663
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Fax | 704-597-5313
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Provider Business Mailing Address
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Address Line | PO BOX 480597
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City | CHARLOTTE
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State | NC
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Zip | 28269-5321
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Country | US
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Telephone | 704-596-6663
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Fax | 704-597-5313
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN L NOTA
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Credential | CEAS, CEFE
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Telephone | 704-596-6663
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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 | 5342
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License Number State | NC
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