NPIMap

Organization Active NPI

Bodywise Physical Therapy

  • Physical Therapist
  • Minden, NV
National Provider Identifier
1003090705
Registry record updated Mar 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1784 Issued in NV
Legal business name
BODYWISE PHYSICAL THERAPY
Practice address
1667 Lucerne St Ste B
Minden, NV 89423-4360
Phone
(775) 783-7606
Fax
(775) 783-7605
NPI assigned
Dec 18, 2007
Last updated
Mar 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Monique B Haviland, M.S.P.T.NPI 1164472320
Title
Ceo/Physical Therapist
Phone
(775) 783-7606

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 1784 NV Primary

Addresses

Primary practice location

1667 Lucerne St Ste B
Minden, NV 89423-4360

Mailing address

PO Box 280
Minden, NV 89423-0280
Phone (775) 783-7606

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100804001216 NV Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0345373767 Receives reassigned benefits from 8 practitioners
Practice locations: Carson City, NV; Gardnerville, NV; Minden, NV

National Provider Directory

National Provider Directory

Locations

931 Mica Dr
Ste 1
Carson City, NV 89705
Phone (775) 267-3396

1667 Lucerne St
Ste B
Minden, NV 89423
Phone 7757475050123

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583366400000",
    "number": "1003090705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280",
            "city": "MINDEN",
            "state": "NV",
            "postal_code": "894230280",
            "telephone_number": "775-783-7606",
            "fax_number": "775-783-7605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1667 LUCERNE ST STE B",
            "city": "MINDEN",
            "state": "NV",
            "postal_code": "894234360",
            "telephone_number": "775-783-7606",
            "fax_number": "775-783-7605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BODYWISE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-18",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A",
        "authorized_official_last_name": "HAVILAND",
        "authorized_official_first_name": "MONIQUE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "775-783-7606",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.S.P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NV",
            "license": "1784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minden, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.