Provider Demographics
NPI:1891747721
Name:DEVINE, JODI L (PT)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:L
Last Name:DEVINE
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 1:1204 MAIN AVE S
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-3839
Mailing Address - Country:US
Mailing Address - Phone:605-692-4325
Mailing Address - Fax:
Practice Address - Street 1:1204 MAIN AVE S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-3839
Practice Address - Country:US
Practice Address - Phone:056-692-4325
Practice Address - Fax:605-301-4141
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00732060OtherRAILROAD MEDICARE
SDS102672Medicare PIN