Provider Demographics
NPI:1821375189
Name:JKD THERAPY & BODY WERX LLC
Entity Type:Organization
Organization Name:JKD THERAPY & BODY WERX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, JKD THERAPY & BODY WERX L
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:765-247-4901
Mailing Address - Street 1:PO BOX 923
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-0923
Mailing Address - Country:US
Mailing Address - Phone:765-247-4901
Mailing Address - Fax:765-246-4088
Practice Address - Street 1:1140 INDIANAPOLIS RD
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-1458
Practice Address - Country:US
Practice Address - Phone:765-247-4901
Practice Address - Fax:765-246-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006979A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy