Bodyworx Physical Therapy & Chiropractic Wellness Center Pllc | |
1451 Diederich Blvd, Russell, KY 41169-1718 | |
(606) 833-2173 | |
Not Available |
Full Name | Bodyworx Physical Therapy & Chiropractic Wellness Center Pllc |
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Type | Facility |
Speciality | Physical Therapist |
Location | 1451 Diederich Blvd, Russell, Kentucky |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1598819468 | NPI | - | NPPES |
1188596 | Other | KY | CHA PROVIDER NUMBER |
85900272 | Medicaid | KY | |
85001501 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 4634 (Kentucky) | Secondary |
225100000X | Physical Therapist | 005907 (Kentucky) | Primary |
225100000X | Physical Therapist | (* (Not Available)) | Secondary |
Provider Name | Jeremy Ryan Stephenson |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1215470125 PECOS PAC ID: 8022447671 Enrollment ID: I20200404000105 |
Provider Name | Brad Lee Profitt |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1518055714 PECOS PAC ID: 3476720160 Enrollment ID: I20240418004038 |
Provider Name | Neil Alan Evans |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1356400592 PECOS PAC ID: 7911908397 Enrollment ID: I20240419001134 |
Mailing Address | Practice Location Address |
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Bodyworx Physical Therapy & Chiropractic Wellness Center Pllc 1451 Diederich Blvd, Russell, KY 41169-1718 Ph: (606) 836-6683 | Bodyworx Physical Therapy & Chiropractic Wellness Center Pllc 1451 Diederich Blvd, Russell, KY 41169-1718 Ph: (606) 833-2173 |
Jeremy Stephenson, Physical Therapist Medicare: Medicare Enrolled Practice Location: 1451 Diederich Blvd, Russell, KY 41169 Phone: 606-836-6683 | |
Anita Frazier-brooks, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 452 Bluebird Dr, Russell, KY 41169 Phone: 606-922-2596 |