Provider Demographics
NPI:1487810891
Name:BODDIE, LASHAWNDA DEL (PT)
Entity type:Individual
Prefix:
First Name:LASHAWNDA
Middle Name:DEL
Last Name:BODDIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2473 CRESCENT GLEN CIRCLE
Mailing Address - Street 2:#210
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133
Mailing Address - Country:US
Mailing Address - Phone:812-327-0992
Mailing Address - Fax:
Practice Address - Street 1:2473 CRESCENT GLEN CIRCLE
Practice Address - Street 2:#210
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133
Practice Address - Country:US
Practice Address - Phone:812-327-0992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8958225100000X
IN05008081A225100000X
KY004786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist