Provider Demographics
NPI:1194184572
Name:WINGERT, JODY (LMT)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:WINGERT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4334 W CENTRAL AVE
Mailing Address - Street 2:SUITE 232
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4334 W CENTRAL AVE
Practice Address - Street 2:SUITE 232
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1681
Practice Address - Country:US
Practice Address - Phone:419-466-0850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.011294172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist