Provider Demographics
NPI:1225390776
Name:BODE, JANICE M (PT)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:M
Last Name:BODE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:M
Other - Last Name:DIMMITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7510 STATE LINE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3615
Mailing Address - Country:US
Mailing Address - Phone:913-291-2290
Mailing Address - Fax:913-291-2449
Practice Address - Street 1:7510 STATE LINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3615
Practice Address - Country:US
Practice Address - Phone:913-291-2290
Practice Address - Fax:913-291-2449
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01726225100000X
KS11-04342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist