Provider Demographics
NPI:1710158514
Name:BURDITT, JODIE LYNN (PT)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:LYNN
Last Name:BURDITT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:LYNN
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11701 BORMAN DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4100
Mailing Address - Country:US
Mailing Address - Phone:314-983-9555
Mailing Address - Fax:
Practice Address - Street 1:11701 BORMAN DR
Practice Address - Street 2:SUITE 280
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4100
Practice Address - Country:US
Practice Address - Phone:314-983-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist