MEDICARE: ONE BODY ONE LIFE PHYSICAL THERAPY, LLC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1427601137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE BODY ONE LIFE PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	9640 ZIG ZAG
Second Line	:
City	:	MONTGOMERY
State	:	OH
Zip	:	45242
Country	:	US
Telephone Number	:	513-236-8635
Fax Number	:

Provider Business Practice Location Address
First Line	:	3908 MIAMI RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-3705
Country	:	US
Telephone Number	:	513-760-5511
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DR. STACEY L HENDRICKS
Credential	:	DPT, WCS
Telephone Number	:	513-760-5511

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	07/22/2019

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