Healthcare Provider Details

I. General information

NPI: 1194384172
Provider Name (Legal Business Name): RACHAEL MARIE BODE M.ED, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W CAMELBACK RD
PHOENIX AZ
85017-3030
US

IV. Provider business mailing address

3300 W CAMELBACK RD
PHOENIX AZ
85017-3030
US

V. Phone/Fax

Practice location:
  • Phone: 602-639-7500
  • Fax:
Mailing address:
  • Phone: 602-639-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberATR-001646
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: