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General NPI Number Information
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NPI Number | 1699306407
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Entity Type | Organization
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Legal Business Name | BODY AND MIND PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 05/14/2021
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Provider Practice Location Address
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Address Line | 1125 E 17TH ST STE W237
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City | SANTA ANA
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State | CA
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Zip | 92701-2205
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Country | US
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Telephone | 714-760-4577
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 E 17TH ST STE W237
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City | SANTA ANA
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State | CA
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Zip | 92701-2205
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Country | US
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Telephone | 908-295-6187
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAEIDEH BADIEFARD
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Credential |
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Telephone | 908-295-6187
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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 |
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License Number State |
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