Provider Demographics
NPI:1467770651
Name:KLEMM, JODI L (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:L
Last Name:KLEMM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:JODI
Other - Middle Name:L
Other - Last Name:ECKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:593 COLLIER DR.
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-2526
Mailing Address - Country:US
Mailing Address - Phone:262-818-1182
Mailing Address - Fax:
Practice Address - Street 1:593 COLLIER DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-8913
Practice Address - Country:US
Practice Address - Phone:262-818-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160-003144225200000X
WI1052-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant