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Individual

MR. BRENT BODE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
807 N JEFFERSON ST, MILWAUKEE, WI 53202-8150
(414) 224-8219
(414) 224-8246
Mailing address
1177 QUAIL CT, SUITE 200, PEWAUKEE, WI 53072-3790
(262) 695-3057
(262) 695-3063

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10968
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
361161700
WI
01
APPLIED FOR
ALL NUMBERS APPLIED FOR
WI
Enumeration date
02/13/2008
Last updated
08/03/2010
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