Provider Demographics
NPI:1902429442
Name:THE BODY SHOP PHYSICAL THERAPY
Entity Type:Organization
Organization Name:THE BODY SHOP PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ELGIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT, OCS
Authorized Official - Phone:605-645-2806
Mailing Address - Street 1:7 O SPEAR RD
Mailing Address - Street 2:
Mailing Address - City:BIDDLE
Mailing Address - State:MT
Mailing Address - Zip Code:59314-9511
Mailing Address - Country:US
Mailing Address - Phone:605-645-2806
Mailing Address - Fax:
Practice Address - Street 1:117 EAST WILSON AVENUE
Practice Address - Street 2:
Practice Address - City:BROADUS
Practice Address - State:MT
Practice Address - Zip Code:59317
Practice Address - Country:US
Practice Address - Phone:406-436-2110
Practice Address - Fax:949-655-7819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy