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General NPI Number Information
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NPI Number | 1609120245
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Entity Type | Organization
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Legal Business Name | BODY HOLISTICS INC
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 10707 66TH ST N SUITE F
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City | PINELLAS PARK
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State | FL
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Zip | 33782-2352
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Country | US
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Telephone | 727-329-8698
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Fax | 727-329-8698
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Provider Business Mailing Address
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Address Line | 10707 66TH ST N SUITE F
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City | PINELLAS PARK
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State | FL
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Zip | 33782-2352
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Country | US
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Telephone | 727-329-8698
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Fax | 727-329-8698
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Authorized Official
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Title or Position | OWNER
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Name | MS. RUTH ADELE COOPEE
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Credential | OTR/L, CLT, LMT
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Telephone | 727-329-8698
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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 | MA#64262
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | OT#13546
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License Number State | FL
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