Provider Demographics
NPI:1285875526
Name:FIZER, JODI MARGARET (PT)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:MARGARET
Last Name:FIZER
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 1:3 TURTLEBACK TRL
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2564
Mailing Address - Country:US
Mailing Address - Phone:904-280-4312
Mailing Address - Fax:904-273-2983
Practice Address - Street 1:3 TURTLEBACK TRL
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-2564
Practice Address - Country:US
Practice Address - Phone:904-280-4312
Practice Address - Fax:904-273-2983
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist