Healthcare Provider Details

I. General information

NPI: 1154460343
Provider Name (Legal Business Name): ANNE HILL BODDY D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ANNE KATHLEEN HILL

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 SOUTHPARK BLVD SUITE 100
ST AUGUSTINE FL
32086-4120
US

IV. Provider business mailing address

1413 VISTA COVE RD
ST AUGUSTINE FL
32084-3036
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-1478
  • Fax: 904-824-8071
Mailing address:
  • Phone: 94-808-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22764
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: