Provider Demographics
NPI:1699807669
Name:MEDELL, JODI LYNN (PT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:MEDELL
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:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-0154
Mailing Address - Country:US
Mailing Address - Phone:970-251-5462
Mailing Address - Fax:
Practice Address - Street 1:TREASURY CENTER 10
Practice Address - Street 2:CRESTED BUTTE WAY STE L2
Practice Address - City:MT. CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81225-0154
Practice Address - Country:US
Practice Address - Phone:970-251-5462
Practice Address - Fax:970-251-5463
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM400521225Medicare UPIN