Victoria M. Bodner, L.M.T.
Individual provider Active NPI Massage Therapist · Lakewood, OH
NPI 1184969784 · NPPES record last updated Jan 22, 2016
Key facts
- NPI
- 1184969784
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 33.007239 (OH)
- Practice address
- 13314 Detroit Ave
Lakewood, OH 44107-2850 - Phone
- (216) 621-3043
- NPI assigned
- Dec 7, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33.007239 | OH | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 33.007239 | OH | Yes |
Addresses
Primary practice location
13314 Detroit Ave
Lakewood, OH 44107-2850
Mailing address
13314 Detroit Ave
Lakewood, OH 44107-2850
Phone (216) 621-3043
Other providers in Lakewood, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.