Provider Demographics
NPI:1861689002
Name:RICHARD BODIAN, PT
Entity Type:Organization
Organization Name:RICHARD BODIAN, PT
Other - Org Name:ONE ON ONE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:OFRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-370-3500
Mailing Address - Street 1:1655 RICHMOND AVE
Mailing Address - Street 2:SUITE B102
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1570
Mailing Address - Country:US
Mailing Address - Phone:718-370-3500
Mailing Address - Fax:718-370-9724
Practice Address - Street 1:1390 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-2103
Practice Address - Country:US
Practice Address - Phone:718-642-1100
Practice Address - Fax:718-642-2546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013808-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty