Provider Demographics
NPI:1891733093
Name:SODEMANN, JEFFREY PAUL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:PAUL
Last Name:SODEMANN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1043 EXECUTIVE DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3998
Mailing Address - Country:US
Mailing Address - Phone:423-870-6004
Mailing Address - Fax:423-870-6005
Practice Address - Street 1:1043 EXECUTIVE DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3998
Practice Address - Country:US
Practice Address - Phone:423-870-6004
Practice Address - Fax:423-870-6005
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNPT0000000341225100000X
GAPT000554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3110918OtherBLUECROSS BLUESHILD OF TN
TN3110918OtherBLUECROSS BLUESHILD OF TN
GA116565Medicare ID - Type Unspecified