Provider Demographics
NPI:1639661812
Name:BODTKER, BETH ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANNE
Last Name:BODTKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:G3346 BEECHER RD STE B
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3649
Mailing Address - Country:US
Mailing Address - Phone:810-221-7555
Mailing Address - Fax:810-221-7550
Practice Address - Street 1:G3346 BEECHER RD STE B
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3649
Practice Address - Country:US
Practice Address - Phone:810-221-7555
Practice Address - Fax:810-221-7550
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist