Provider Demographics
NPI:1144508656
Name:BODY-MECHANIC LLC
Entity type:Organization
Organization Name:BODY-MECHANIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:FLAVIA
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:813-300-2321
Mailing Address - Street 1:10141 PINK PALMATA CT
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3626
Mailing Address - Country:US
Mailing Address - Phone:813-300-2321
Mailing Address - Fax:
Practice Address - Street 1:10141 PINK PALMATA CT
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3626
Practice Address - Country:US
Practice Address - Phone:813-300-2321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA38042174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty