Mbody Physical Therapy, LLC

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

14338 Issued in NC

Legal business name

MBODY PHYSICAL THERAPY, LLC

Doing business as

MBody Physical Therapy

Practice address

5200 Park Road
Suite 235
Charlotte, NC 28209-3651

Phone

(980) 288-4646

NPI assigned

Jun 24, 2015

Organization subpart

No

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

Authorized official

Name

Mrs. Lisa Marie Vander Bloomer, PT

Title

Owner / Physical Therapist

Phone

(980) 288-4646

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MBody Physical Therapy Doing business as

Locations

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

{
    "created_epoch": "1435104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435190400000",
    "number": "1831571900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 PARK ROAD",
            "address_2": "SUITE 235",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093651",
            "telephone_number": "980-288-4646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 PARK ROAD",
            "address_2": "SUITE 235",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093651",
            "telephone_number": "980-288-4646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MBODY PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-24",
        "last_updated": "2015-06-25",
        "status": "A",
        "authorized_official_last_name": "VANDER BLOOMER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER / PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "980-288-4646",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NC",
            "license": "14338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Q44318A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MBody Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Erica Mazur, M.ED., BCBA
• Melissa G. Mazur, CRNA
• Shelley A. Mazzie, MPT
• Deanna L Mazzullo
• Sophy Riziki Mbeyu
• Dorothea Paulette Mbote
• MBS Therapeutics PLLC
• MBS Therapy and Wellness
• Caroline Wambui Mbugua, FNP-BC
• Karen Mbumina

• Orthopedic Physical Therapist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Orthopedic Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.