Provider Demographics
NPI:1194754812
Name:MARAM, JODI (PT)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:
Last Name:MARAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:GOLDFAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:777 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 116E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8705
Mailing Address - Country:US
Mailing Address - Phone:314-985-3002
Mailing Address - Fax:314-985-3012
Practice Address - Street 1:10435 CLAYTON RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FRONTENAC
Practice Address - State:MO
Practice Address - Zip Code:63131-2909
Practice Address - Country:US
Practice Address - Phone:314-985-3002
Practice Address - Fax:314-985-3012
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1183732251X0800X
IL2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic