Provider Demographics
NPI:1154460343
Name:BODDY, ANNE HILL (DPT)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:HILL
Last Name:BODDY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:ANNE
Other - Middle Name:KATHLEEN
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1413 VISTA COVE RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-3036
Mailing Address - Country:US
Mailing Address - Phone:094-808-1239
Mailing Address - Fax:
Practice Address - Street 1:190 SOUTHPARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4120
Practice Address - Country:US
Practice Address - Phone:904-824-1478
Practice Address - Fax:904-824-8071
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist