Provider Demographics
NPI:1912498387
Name:BODAS, SETH (DPT)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:BODAS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5932 BLAINE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PLYMOUTH
Mailing Address - State:ID
Mailing Address - Zip Code:83655-5207
Mailing Address - Country:US
Mailing Address - Phone:208-230-4347
Mailing Address - Fax:
Practice Address - Street 1:840 SW 4TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2638
Practice Address - Country:US
Practice Address - Phone:541-881-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-5702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist