Provider Demographics
NPI:1346829728
Name:WARD, JODIE AMANDA (LMT)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:AMANDA
Last Name:WARD
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 1:201 KEITH ST SW STE 56
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-5867
Mailing Address - Country:US
Mailing Address - Phone:423-559-0380
Mailing Address - Fax:
Practice Address - Street 1:201 KEITH ST SW STE 56
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-5867
Practice Address - Country:US
Practice Address - Phone:423-559-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000010596225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist