Provider Demographics
NPI:1073214284
Name:BODIN, CARRIE LEWIS (MPT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LEWIS
Last Name:BODIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 37586
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3586
Mailing Address - Country:US
Mailing Address - Phone:410-822-4613
Mailing Address - Fax:410-822-6534
Practice Address - Street 1:611 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-1157
Practice Address - Country:US
Practice Address - Phone:302-684-2829
Practice Address - Fax:302-684-1325
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist