Provider Demographics
NPI:1518254838
Name:MOHLE, JODY PAITRA (PT DPT)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:PAITRA
Last Name:MOHLE
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2059 ALTAMONT AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-3281
Mailing Address - Country:US
Mailing Address - Phone:239-400-5639
Mailing Address - Fax:866-835-2456
Practice Address - Street 1:2059 ALTAMONT AVE STE 105
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901
Practice Address - Country:US
Practice Address - Phone:239-400-5639
Practice Address - Fax:866-835-2456
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT290362251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic