Provider Demographics
NPI:1275728396
Name:BODNER, CHRISTINE M (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:BODNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:BODNER-NYBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:390 LINCOLN ST STE 230
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6021
Mailing Address - Country:US
Mailing Address - Phone:541-255-2095
Mailing Address - Fax:541-255-2445
Practice Address - Street 1:390 LINCOLN ST STE 230
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6021
Practice Address - Country:US
Practice Address - Phone:541-255-2095
Practice Address - Fax:541-255-2445
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218696Medicaid
ORR190152OtherMEDICARE PTAN