Healthcare Provider Details

I. General information

NPI: 1831649607
Provider Name (Legal Business Name): CARLENE VICTORIA BODENSCHATZ P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLENE VICTORIA MARTIN P.T.

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 09/02/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24723 DETROIT RD
WESTLAKE OH
44145
US

IV. Provider business mailing address

24723 DETROIT RD
WESTLAKE OH
44145
US

V. Phone/Fax

Practice location:
  • Phone: 440-348-3802
  • Fax: 440-348-3761
Mailing address:
  • Phone: 440-348-3802
  • Fax: 440-348-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7820
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: