Provider Demographics
NPI:1194045286
Name:BUNGE, JODI LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYNN
Last Name:BUNGE
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 1:350 N GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6388
Mailing Address - Country:US
Mailing Address - Phone:563-557-2860
Mailing Address - Fax:563-557-2834
Practice Address - Street 1:350 N GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6388
Practice Address - Country:US
Practice Address - Phone:563-557-2860
Practice Address - Fax:563-557-2834
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist