Provider Demographics
NPI:1437247665
Name:TJELTA, JODI ANN (PT/ATC)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:ANN
Last Name:TJELTA
Suffix:
Gender:F
Credentials:PT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 1ST AVE S
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW ROCKFORD
Mailing Address - State:ND
Mailing Address - Zip Code:58356-1800
Mailing Address - Country:US
Mailing Address - Phone:701-947-2030
Mailing Address - Fax:
Practice Address - Street 1:207 1ST AVE S
Practice Address - Street 2:SUITE C.
Practice Address - City:NEW ROCKFORD
Practice Address - State:ND
Practice Address - Zip Code:58356-1800
Practice Address - Country:US
Practice Address - Phone:701-947-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND55025Medicaid
ND25514OtherBCBS ND PROVIDER NUMBER
ND55025Medicaid
NDQ47437Medicare UPIN