# BODYGENIC PHYSICAL THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184184756
- **Authorized official:** DR. RYAN FULLINGTON (PHYSICAL THERAPIST, OWNER)
- **Authorized official phone:** (262) 364-9221

## Contact information

- **Practice address:** 950 WESTON HILLS DR, BROOKFIELD, WI 53045-3758
- **Practice address phone:** (262) 364-9221
- **Mailing address:** PO BOX 2232, BROOKFIELD, WI 53008-2232
- **Mailing address phone:** (262) 364-9221

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 03/21/2019
- **Last updated:** 03/21/2019