Provider Demographics
NPI:1730796723
Name:BODOLAY, NATALIE ALEJANDRA (DPT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ALEJANDRA
Last Name:BODOLAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 BROAD ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3006
Mailing Address - Country:US
Mailing Address - Phone:352-989-5838
Mailing Address - Fax:352-404-8979
Practice Address - Street 1:10887 NW 17TH ST STE 108-109
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-2060
Practice Address - Country:US
Practice Address - Phone:786-359-4999
Practice Address - Fax:786-359-4843
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist