Provider Demographics
NPI:1982906772
Name:WORRELL, JODI HARPER (LPTA)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:HARPER
Last Name:WORRELL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5356 BEAMER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-9581
Mailing Address - Country:US
Mailing Address - Phone:540-616-4070
Mailing Address - Fax:
Practice Address - Street 1:5356 BEAMER HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-9581
Practice Address - Country:US
Practice Address - Phone:540-616-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306601849225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant