Provider Demographics
NPI:1649494378
Name:BODKIN, DANIEL MODELL (PT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MODELL
Last Name:BODKIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9 STONY HILL LN
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2015
Mailing Address - Country:US
Mailing Address - Phone:845-786-4673
Mailing Address - Fax:845-786-4650
Practice Address - Street 1:HELEN HAYES HOSPITAL
Practice Address - Street 2:51-55 ROUTE 9W
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1195
Practice Address - Country:US
Practice Address - Phone:845-786-4673
Practice Address - Fax:845-786-4650
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist