Provider Demographics
NPI:1073054508
Name:HIX, JODIE S
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:S
Last Name:HIX
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JODIE
Other - Middle Name:
Other - Last Name:SCHOFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1250 FAWN CIR
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-6600
Mailing Address - Country:US
Mailing Address - Phone:307-872-3290
Mailing Address - Fax:
Practice Address - Street 1:1715 HITCHING POST DRIVE
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-6600
Practice Address - Country:US
Practice Address - Phone:307-872-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPTA-0625225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant