Provider Demographics
NPI:1376525220
Name:ADAMS, JODIE MAE (PT)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:MAE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:MAE
Other - Last Name:PADGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 BROADWAY ST.
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663
Mailing Address - Country:US
Mailing Address - Phone:360-737-3346
Mailing Address - Fax:360-694-7356
Practice Address - Street 1:20055 SW PACIFIC HWY
Practice Address - Street 2:STE 110
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9294
Practice Address - Country:US
Practice Address - Phone:503-625-1691
Practice Address - Fax:503-926-1460
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5033225100000X
WAPT60119188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269836Medicaid
OR131993Medicare PIN