Provider Demographics
NPI:1053584912
Name:BODDICKER, MARY CHRISTINE FILLIUS (PT, DPT, PRPC)
Entity type:Individual
Prefix:MRS
First Name:MARY CHRISTINE
Middle Name:FILLIUS
Last Name:BODDICKER
Suffix:
Gender:F
Credentials:PT, DPT, PRPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46135 N GREENS REST DR
Mailing Address - Street 2:
Mailing Address - City:GREAT MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20634-3065
Mailing Address - Country:US
Mailing Address - Phone:302-382-0607
Mailing Address - Fax:
Practice Address - Street 1:46135 N GREENS REST DR
Practice Address - Street 2:
Practice Address - City:GREAT MILLS
Practice Address - State:MD
Practice Address - Zip Code:20634-3065
Practice Address - Country:US
Practice Address - Phone:302-382-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist