Provider Demographics
NPI:1972115129
Name:NEWCOME, JODI
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:
Last Name:NEWCOME
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:108 LOIS LN
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-1201
Mailing Address - Country:US
Mailing Address - Phone:724-991-4888
Mailing Address - Fax:
Practice Address - Street 1:108 LOIS LN
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-1201
Practice Address - Country:US
Practice Address - Phone:724-991-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003397225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant