Provider Demographics
NPI:1689146391
Name:BODINE, ROBIN (DPT)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:BODINE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:PANZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3800 PIKE RD APT 14303
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-8994
Mailing Address - Country:US
Mailing Address - Phone:612-709-3760
Mailing Address - Fax:
Practice Address - Street 1:625 MAIN ST STE 1B
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1893
Practice Address - Country:US
Practice Address - Phone:720-510-3984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.00160992251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic