Individual provider · NPI-1

Stephan Bodkin, MEd, ATC

Specialist/Technologist, Athletic Trainer · Charlottesville, VA

NPI number1164935763
StatusActive
Last updated in NPPESNov 6, 2017

Details

NPI
1164935763
Entity type
Individual (NPI-1)
Name
Stephan Bodkin
Credential
MEd, ATC
Sex
Male
Sole proprietor
Yes
Enumeration date
Nov 6, 2017
Last updated
Nov 6, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer0126002357VAYes

Practice location

210 Emmet St S
Charlottesville, VA 22903-2455

Phone 434-924-6184

Mailing address

1657 Wickliffe Rd
Berryville, VA 22611-2558

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