Provider Demographics
NPI:1235189416
Name:BODNAR, SARAH ERWIN (PT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ERWIN
Last Name:BODNAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 FAIRMOUNT AVE
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5466
Mailing Address - Country:US
Mailing Address - Phone:410-494-1324
Mailing Address - Fax:410-494-1361
Practice Address - Street 1:515 FAIRMOUNT AVE
Practice Address - Street 2:SUITE 530
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-494-1343
Practice Address - Fax:410-494-1386
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD007063880Medicaid
MD650014030Medicare PIN
MD007063880Medicaid
MD109M005FMedicare PIN