Provider Demographics
NPI:1922161744
Name:BARTH, JODI (PT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:BARTH
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 1:6110 EXECUTIVE BOULEVARD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:240-833-2921
Mailing Address - Fax:240-833-2937
Practice Address - Street 1:6110 EXECUTIVE BOULEVARD
Practice Address - Street 2:SUITE 460
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:240-833-2921
Practice Address - Fax:240-833-2937
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist