Provider Demographics
NPI:1780733329
Name:BODALIA REHAB SVCS
Entity type:Organization
Organization Name:BODALIA REHAB SVCS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NIKETA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:706-507-5307
Mailing Address - Street 1:2457 AIRPORT THRUWAY
Mailing Address - Street 2:315
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904
Mailing Address - Country:US
Mailing Address - Phone:706-507-5307
Mailing Address - Fax:706-507-5311
Practice Address - Street 1:18601 E SILVERHILL RD
Practice Address - Street 2:B
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567
Practice Address - Country:US
Practice Address - Phone:251-947-7911
Practice Address - Fax:251-947-2697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy