MEDICARE: EMBODY PHYSIO 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	:	1760117246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBODY PHYSIO LLC

Provider Business Mailing Address
First Line	:	10715 NE 37TH CT APT 129
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-1703
Country	:	US
Telephone Number	:	559-392-8595
Fax Number	:

Provider Business Practice Location Address
First Line	:	10715 NE 37TH CT APT 129
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-1703
Country	:	US
Telephone Number	:	559-392-8595
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	DR. ERICA BEA BROOK
Credential	:	PT
Telephone Number	:	559-392-8595

Provider Enumeration Date	:	07/19/2022
Last Update Date	:	07/19/2022

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