Individual
STEPHAN BODKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MED, ATC
Contact information
Practice address
210 EMMET ST S, CHARLOTTESVILLE, VA 22903-2455
(434) 924-6184
Mailing address
1657 WICKLIFFE RD, BERRYVILLE, VA 22611-2558
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126002357
VA
Other
Enumeration date
11/06/2017
Last updated
11/06/2017
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