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General NPI Number Information
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NPI Number | 1053016469
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Entity Type | Individual
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Provider Name | ARAILIA BODDIE
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Gender | Female
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Dates
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Enumeration Date | 04/04/2023
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 280 MT HEBRON RD
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City | ELMORE
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State | AL
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Zip | 36025-1526
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Country | US
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Telephone | 334-567-8484
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Fax |
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Provider Business Mailing Address
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Address Line | 6654 TAYLOR RIDGE RD
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City | MONTGOMERY
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State | AL
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Zip | 36116-6540
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Country | US
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Telephone | 334-231-0145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 11046
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License Number State | AL
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