MEDICARE: BODY SYSTEMS LIMITED LIABILITY COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	1191	AK

General Provider Information

NPI Number	:	1316440100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY SYSTEMS LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	5185 W 80TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-4114
Country	:	US
Telephone Number	:	907-351-2052
Fax Number	:

Provider Business Practice Location Address
First Line	:	5185 W 80TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-4114
Country	:	US
Telephone Number	:	907-351-2052
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID PAT DISSELBRETT
Credential	:	MSPT, JSCC
Telephone Number	:	907-351-2052

Provider Enumeration Date	:	03/17/2018
Last Update Date	:	03/17/2018

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Directions to “BODY SYSTEMS LIMITED LIABILITY COMPANY ” Practice Location

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