MEDICARE: BODYBASICS PHYSICAL THERAPY, INC.

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		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ09067Z	OTHER	CA	BLUE SHIELD OF CALIFORNIA

General Provider Information

NPI Number	:	1487651097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODYBASICS PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	2275 S MAIN ST STE 102
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92882-5303
Country	:	US
Telephone Number	:	951-273-7742
Fax Number	:	951-273-7747

Provider Business Practice Location Address
First Line	:	3178 HAMNER AVE STE 4
Second Line	:
City	:	NORCO
State	:	CA
Zip	:	92860-1936
Country	:	US
Telephone Number	:	951-736-5646
Fax Number	:	951-736-5694

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT HUNSAKER
Credential	:	PT
Telephone Number	:	951-736-5646

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	01/26/2021

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