Provider Demographics
NPI:1285879684
Name:MATHEWS, JODI L (LMT)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6349 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE HEIGHTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656-8898
Mailing Address - Country:US
Mailing Address - Phone:352-473-5049
Mailing Address - Fax:
Practice Address - Street 1:900 NW 8TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5059
Practice Address - Country:US
Practice Address - Phone:352-745-2092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-14
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA34976225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist