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General NPI Number Information
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NPI Number | 1780746487
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Entity Type | Individual
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Provider Name | THERESA BODINE PA
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Gender | Female
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Dates
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Enumeration Date | 12/16/2006
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 200 NORTH ST
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City | GENEVA
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State | NY
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Zip | 14456-1561
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Country | US
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Telephone | 315-787-5100
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Fax | 315-787-5108
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Provider Business Mailing Address
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Address Line | 571 SAINT JOSEPHS BLVD FL 2
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City | ELMIRA
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State | NY
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Zip | 14901-3230
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Country | US
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Telephone | 607-271-2050
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Fax | 607-873-1244
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 004448-1
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License Number State | NY
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