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Individual

CHARLOTTE ELLEN GRACE BODACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
4250 HEMPSTEAD TPKE, BETHPAGE, NY 11714-5711
(516) 579-7870
Mailing address
1650 LYNDON FARM CT STE 300, LOUISVILLE, KY 40223-5005

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
054732
NY

Other

Enumeration date
02/17/2026
Last updated
02/17/2026
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