Provider Demographics
NPI:1386806776
Name:WEST, JODI LEE (PT)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LEE
Last Name:WEST
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 1:3302 TIMBERBROOK CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-8515
Mailing Address - Country:US
Mailing Address - Phone:317-892-3537
Mailing Address - Fax:
Practice Address - Street 1:1111 NORTH RONALD REAGAN PARKWAY
Practice Address - Street 2:MG214
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123
Practice Address - Country:US
Practice Address - Phone:317-217-3070
Practice Address - Fax:317-217-3073
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001907A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist