Provider Demographics
NPI:1013026681
Name:STONE, JODI LEE (PT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LEE
Last Name:STONE
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 1:1039 BUCKHORN BND
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3449
Mailing Address - Country:US
Mailing Address - Phone:678-545-1859
Mailing Address - Fax:
Practice Address - Street 1:1332 S. ZACH HINTON PARKWAY
Practice Address - Street 2:SUITE C
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253
Practice Address - Country:US
Practice Address - Phone:770-898-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT 008563OtherLICENSE #