Provider Demographics
NPI:1578044624
Name:STAHR, JODY JELLEY
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:JELLEY
Last Name:STAHR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4861
Mailing Address - Country:US
Mailing Address - Phone:614-946-3564
Mailing Address - Fax:
Practice Address - Street 1:499 E WEISHEIMER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2238
Practice Address - Country:US
Practice Address - Phone:614-365-5229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist