Provider Demographics
NPI:1902102577
Name:BODY RESTORATION, LLC
Entity Type:Organization
Organization Name:BODY RESTORATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSPT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LUDOVICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-769-1100
Mailing Address - Street 1:26 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-1115
Mailing Address - Country:US
Mailing Address - Phone:856-769-1100
Mailing Address - Fax:
Practice Address - Street 1:26 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08098-1115
Practice Address - Country:US
Practice Address - Phone:856-769-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00749600261QP2000X
PAPT005800L261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
093092Medicare UPIN