Organization
BODEN FITNESS SYSTEM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORDAN LE TRAN M.D. (MEDICAL DIRECTOR)
(540) 508-0779
Entity
Organization
Contact information
Practice address
125 PROSPERITY DR, SUITE 500B, WINCHESTER, VA 22602-5385
(540) 508-0779
(540) 508-0841
Mailing address
125 PROSPERITY DR, SUITE 500B, WINCHESTER, VA 22602-5385
(540) 508-0779
(540) 508-0841
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
0101256096
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VV748A
MEDICARE PTAN
VA
Enumeration date
12/02/2016
Last updated
12/02/2016
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