Organization
BODY PHYSICAL THERAPY AND FITNESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICANOR LUMBRE BOBADILLA I (PRESIDENT / CEO)
(818) 789-6474
Entity
Organization
Contact information
Practice address
7702 BALBOA BLVD, SUITE 6, VAN NUYS, CA 91406-2244
(818) 789-6474
(818) 789-6467
Mailing address
7702 BALBOA BLVD, SUITE 6, VAN NUYS, CA 91406-2244
(818) 789-6474
(818) 789-6467
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ65116Z
BLUE SHIELD
CA
Enumeration date
05/16/2006
Last updated
10/25/2010
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