Provider Demographics
NPI:1578962627
Name:KALLNER, JODI (PT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:KALLNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 KITTLE RD
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-8812
Mailing Address - Country:US
Mailing Address - Phone:740-574-2083
Mailing Address - Fax:
Practice Address - Street 1:522 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-5505
Practice Address - Country:US
Practice Address - Phone:740-354-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH008451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist