MEDICARE: BODYZ EN MOTION, 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	363LF0000X	Family Nurse Practitioner	AP3329	AZ

General Provider Information

NPI Number	:	1700106101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODYZ EN MOTION, LLC

Provider Business Mailing Address
First Line	:	PO BOX 875
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85380-0875
Country	:	US
Telephone Number	:	623-217-4719
Fax Number	:	623-223-7220

Provider Business Practice Location Address
First Line	:	17215 N 72ND DR BLDG A
Second Line	:	SUITE 105
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8558
Country	:	US
Telephone Number	:	623-217-4719
Fax Number	:	623-223-7220

Authorized Official
Title or Position	:	OWNER/FAMILY NURSE PRACTITIONER
Name	:	SHERI ENGLISH
Credential	:	FNP
Telephone Number	:	623-521-8414

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	06/08/2010

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