MEDICARE: BODALIA REHAB SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	I951	OTHER	AL	MEDICARE LEGACY #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51046794	OTHER	AL	BCBS OF AL

General Provider Information

NPI Number	:	1558452920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODALIA REHAB SERVICES, INC

Provider Business Mailing Address
First Line	:	18601 E SILVERHILL AVE
Second Line	:	SUITE B
City	:	ROBERTSDALE
State	:	AL
Zip	:	36567-3703
Country	:	US
Telephone Number	:	251-747-4118
Fax Number	:	251-947-2697

Provider Business Practice Location Address
First Line	:	18601 E SILVERHILL AVE
Second Line	:	SUITE B
City	:	ROBERTSDALE
State	:	AL
Zip	:	36567-3703
Country	:	US
Telephone Number	:	251-747-4118
Fax Number	:	251-947-2697

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NEHAL BODALIA
Credential	:
Telephone Number	:	251-747-4118

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	06/18/2008

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Directions to “BODALIA REHAB SERVICES, INC ” Practice Location

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