MEDICARE: EMBODY 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	251E00000X	Home Health Agency
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1669172193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBODY PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	3727 E ASTER DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-7328
Country	:	US
Telephone Number	:	602-410-4716
Fax Number	:

Provider Business Practice Location Address
First Line	:	3727 E ASTER DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-7328
Country	:	US
Telephone Number	:	602-410-4716
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	KATHERINE MARIE PRINCIC
Credential	:	PT
Telephone Number	:	602-410-4716

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	03/03/2023

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