Connie Jeanne Bodnarik

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA21710 Issued in FL

Practice address

3780 S Clyde Morris Blvd Apt 1206
Port Orange, FL 32129

Phone

(407) 233-6818

NPI assigned

Dec 2, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1259712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536105600000",
    "number": "1326376385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3780 S CLYDE MORRIS BLVD APT 1206",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321298992",
            "telephone_number": "407-233-6818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3780 S CLYDE MORRIS BLVD APT 1206",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "32129",
            "telephone_number": "407-233-6818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODNARIK",
        "first_name": "CONNIE",
        "middle_name": "JEANNE",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-12-02",
        "last_updated": "2018-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA21710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bloom Behavioral Health LLC
• Willis Blower, LCSW
• Blue Ocean Dermatology LLC
• Kimberly Boan, COTA
• Rishi Tushar Bodalia, DC
• Kathryn Boehm
• Geoffrey Boehme
• Karen M Boggs, LCSW
• Lindsey Bolte, DC
• Tyler Bolvin, RBT

• Physical Therapy Assistant in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.