Provider Demographics
NPI:1184632069
Name:FLANAGAN, JODI KATHRYN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:KATHRYN
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 17TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1300
Mailing Address - Country:US
Mailing Address - Phone:541-523-8888
Mailing Address - Fax:541-523-8889
Practice Address - Street 1:3950 17TH ST STE B
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1300
Practice Address - Country:US
Practice Address - Phone:541-523-8888
Practice Address - Fax:541-523-8889
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR803931003OtherBC/BS OF OREGON
ORP00480330OtherRAILRAOD MEDICARE
OR181501Medicaid
OR181501Medicaid