Provider Demographics
NPI:1427178953
Name:CALDWELL, JO ELLEN (MS, PT,AT,C)
Entity Type:Individual
Prefix:MS
First Name:JO
Middle Name:ELLEN
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MS, PT,AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20031 N 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-2299
Mailing Address - Country:US
Mailing Address - Phone:602-796-5425
Mailing Address - Fax:
Practice Address - Street 1:2020 W WHISPERING WIND DR
Practice Address - Street 2:#119
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-2848
Practice Address - Country:US
Practice Address - Phone:623-889-3480
Practice Address - Fax:623-889-3481
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1386864262OtherBCBS
2Z7238OtherHEALTHNET
208737315OtherTRICARE
AZ116452Medicare PIN