Individual
MRS. NIKETA BODALIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
008191
GA
225100000X
Physical Therapist
Primary
PTH3221
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51046794
BC OF AL
AL
01
—
52183885002
BC OF GA
GA
01
—
I951
MEDICARE GROUP LEGACY#
AL
Enumeration date
09/28/2006
Last updated
08/27/2007
Update your record
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