Individual
MICHELLE BODENHAMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.T.
Contact information
Practice address
50 SKI HILL RD, DRIGGS, ID 83422-0129
(208) 354-3128
Mailing address
PO BOX 129, DRIGGS, ID 83422-0129
(253) 273-3200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2609
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1378483
GROUP NPI
ID
Enumeration date
10/27/2009
Last updated
10/27/2009
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