Provider Demographics
NPI:1225403264
Name:BODIE, RICHMOND
Entity Type:Individual
Prefix:
First Name:RICHMOND
Middle Name:
Last Name:BODIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 VINELAND RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-7375
Mailing Address - Country:US
Mailing Address - Phone:407-426-7066
Mailing Address - Fax:407-426-0556
Practice Address - Street 1:4501 VINELAND RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-7375
Practice Address - Country:US
Practice Address - Phone:407-426-7066
Practice Address - Fax:407-426-0556
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL#40482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer