NPI 1104548197 · live from the CMS NPI Registry
Jody M Allen, DPT
Physical Therapist in Vancouver, WA. National Provider Identifier 1104548197, active.
NPI record
| NPI | 1104548197 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physical Therapist 225100000X |
| Practice location | 501 Se 172nd Ave # 110, Vancouver, WA 98684 |
| Practice phone | 360-329-4836 |
| Mailing address | Po Box 4825, Portland, OR 97208 |
| Enumerated | September 15, 2022 |
| Last updated | March 28, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physical Therapist | 225100000X | 1365131 (TX) |
| Physical Therapist primary | 225100000X | 61352735 (WA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.