Individual
SHELBY NOELLE BODINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
412 N BROADWAY AVE, SHAWNEE, OK 74801-6922
(405) 273-1523
Mailing address
1501 PASTUSEK AVE, 6102 NBU, PRAGUE, OK 74864
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3513
OK
Other
Enumeration date
12/07/2023
Last updated
12/07/2023
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