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General NPI Number Information
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NPI Number | 1457957144
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Entity Type | Organization
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Legal Business Name | BODEN FITNESS DURABLE MEDICAL EQUIPMENT
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 3038 VALLEY AVE
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City | WINCHESTER
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State | VA
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Zip | 22601-2637
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Country | US
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Telephone | 540-508-0651
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Fax | 540-508-0841
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Provider Business Mailing Address
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Address Line | 4 WEEMS LN # 128
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City | WINCHESTER
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State | VA
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Zip | 22601-3602
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Country | US
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Telephone | 540-508-4853
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Fax | 540-585-4081
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Authorized Official
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Title or Position | OWNER
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Name | JORDAN TRAN
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Credential | MD
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Telephone | 540-508-0651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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