MEDICARE: ALL BODY 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	332B00000X	Durable Medical Equipment & Medical Supplies	PT1042	WY

General Provider Information

NPI Number	:	1770723348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL BODY THERAPY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 9725
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83002-9725
Country	:	US
Telephone Number	:	307-733-7037
Fax Number	:	307-733-4955

Provider Business Practice Location Address
First Line	:	1116 MAPLE WAY
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-0000
Country	:	US
Telephone Number	:	307-733-7037
Fax Number	:	307-733-4955

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ANDREA LEWIS
Credential	:	PT
Telephone Number	:	307-413-4268

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	10/09/2009

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Directions to “ALL BODY THERAPY, INC. ” Practice Location

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