Provider Demographics
NPI:1447556733
Name:KING, JODY DAWN (CPTA)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:DAWN
Last Name:KING
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:DAWN
Other - Last Name:WILHELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2800 WILLOW GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2096
Mailing Address - Country:US
Mailing Address - Phone:785-539-7671
Mailing Address - Fax:
Practice Address - Street 1:2800 WILLOW GROVE RD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2096
Practice Address - Country:US
Practice Address - Phone:785-539-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1402084225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant