MEDICARE: BODY CRUSH 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1689258154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY CRUSH LLC

Provider Business Mailing Address
First Line	:	23 MCCARTHY RD
Second Line	:
City	:	PARK FOREST
State	:	IL
Zip	:	60466-2121
Country	:	US
Telephone Number	:	708-955-5012
Fax Number	:

Provider Business Practice Location Address
First Line	:	4071 183RD ST
Second Line	:
City	:	COUNTRY CLUB HILLS
State	:	IL
Zip	:	60478-5306
Country	:	US
Telephone Number	:	708-288-7554
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JANEE MOHAN
Credential	:	DPT
Telephone Number	:	708-955-5012

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	05/10/2021

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Directions to “BODY CRUSH LLC ” Practice Location

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