Provider Demographics
NPI:1467873281
Name:BODNER, STACY (MPT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BODNER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:BETH
Other - Last Name:STRAUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:178 GORDONS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1209
Mailing Address - Country:US
Mailing Address - Phone:732-617-6877
Mailing Address - Fax:
Practice Address - Street 1:178 GORDONS CORNER RD
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1209
Practice Address - Country:US
Practice Address - Phone:732-617-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-20
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00871800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist