Individual
KERRY MICHELLE BODUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2500 NW 229TH AVE BLDG E, STE 200, HILLSBORO, OR 97124-7516
(503) 395-3000
(503) 336-0464
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1244700
TX
225100000X
Physical Therapist
Primary
61167
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1244700
LICENSE #
TX
Enumeration date
07/03/2014
Last updated
07/21/2016
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