Provider Demographics
NPI:1477097178
Name:BODHANWALA, NOZER
Entity Type:Individual
Prefix:
First Name:NOZER
Middle Name:
Last Name:BODHANWALA
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 1:4911 GREEN LAKE WAY N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6734
Mailing Address - Country:US
Mailing Address - Phone:626-922-0990
Mailing Address - Fax:
Practice Address - Street 1:4911 GREEN LAKE WAY N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6734
Practice Address - Country:US
Practice Address - Phone:626-922-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMA60616669225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist