Provider Demographics
NPI:1629122882
Name:COFFEE, JODI SUZANNE (DPT, PT)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:SUZANNE
Last Name:COFFEE
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 COLUMBIA CIR
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-8046
Mailing Address - Country:US
Mailing Address - Phone:870-777-0545
Mailing Address - Fax:
Practice Address - Street 1:508 COLUMBIA CIR
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-8046
Practice Address - Country:US
Practice Address - Phone:870-777-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150666721Medicaid