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General NPI Number Information
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NPI Number | 1538640032
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Entity Type | Individual
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Provider Name | DESIREE LYNN BODIE PHYSICAL THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 200 PATEWOOD DR STE C150
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City | GREENVILLE
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State | SC
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Zip | 29615-6323
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Country | US
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Telephone | 864-482-0972
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Fax |
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Provider Business Mailing Address
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Address Line | 5736 SKYVIEW WAY UNIT G
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City | AGOURA HILLS
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State | CA
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Zip | 91301-5701
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Country | US
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Telephone | 818-590-2559
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT21366
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9246
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License Number State | SC
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