Provider Demographics
NPI:1366081523
Name:BODEWIG, PHOEBE LEO
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:LEO
Last Name:BODEWIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6391 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2336
Mailing Address - Country:US
Mailing Address - Phone:865-585-4026
Mailing Address - Fax:
Practice Address - Street 1:4411 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7211
Practice Address - Country:US
Practice Address - Phone:813-872-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist