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NPI Code Detail

MEDICARE: MS. VICTORIA M. BODNER L.M.T.

MEDICARE: MS. VICTORIA M. BODNER L.M.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist33.007239OH

General Provider Information

NPI Number : 1184969784
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VICTORIA M. BODNER L.M.T.
Provider Business Mailing Address
First Line : 13314 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-2850
Country : US
Telephone Number : 216-621-3043
Fax Number :
Provider Business Practice Location Address
First Line : 13314 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-2850
Country : US
Telephone Number : 216-621-3043
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2012
Last Update Date : 01/22/2016

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