Provider Demographics
NPI:1699890731
Name:PEARCE, JODI T (PT)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:T
Last Name:PEARCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:S
Other - Last Name:TROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4650 E COTTON CENTER BLVD STE 155
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-4803
Mailing Address - Country:US
Mailing Address - Phone:602-892-0915
Mailing Address - Fax:602-926-0910
Practice Address - Street 1:6641 E BAYWOOD AVE STE A4
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1723
Practice Address - Country:US
Practice Address - Phone:480-396-9020
Practice Address - Fax:480-218-9182
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist