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NPI Code Detail

MEDICARE: MRS. SARA LEA BODEM PHYSICAL THERAPIST

MEDICARE:  MRS. SARA LEA BODEM  PHYSICAL THERAPIST
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
1174H00000XHealth Educator1058-24WI

General Provider Information

NPI Number : 1932437001
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SARA LEA BODEM PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 3173 WINDLAND DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-7607
Country : US
Telephone Number : 920-469-7133
Fax Number :
Provider Business Practice Location Address
First Line : 3173 WINDLAND DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-7607
Country : US
Telephone Number : 920-469-7133
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2009
Last Update Date : 11/30/2009

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Directions to “ MRS. SARA LEA BODEM PHYSICAL THERAPIST” Practice Location

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