Healthcare Provider Details

I. General information

NPI: 1003722075
Provider Name (Legal Business Name): GABRIELLE LUCILLE BODIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 MAIN ST STE 1D
STRATFORD CT
06614-4946
US

IV. Provider business mailing address

655 S WILLOW ST STE 128
MANCHESTER NH
03103-5723
US

V. Phone/Fax

Practice location:
  • Phone: 203-378-0092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14555
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: