Provider Demographics
NPI:1043722481
Name:BODIKEY PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:BODIKEY PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:218-639-3449
Mailing Address - Street 1:140 SPYGLASS DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-8750
Mailing Address - Country:US
Mailing Address - Phone:218-639-3449
Mailing Address - Fax:
Practice Address - Street 1:1522 N RIVERFRONT DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:218-639-3449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10635261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy