Provider Demographics
NPI:1356562607
Name:DEUTSCH, JODY NICOLE (LMT, CMLDT)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:NICOLE
Last Name:DEUTSCH
Suffix:
Gender:F
Credentials:LMT, CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1908
Mailing Address - Country:US
Mailing Address - Phone:503-784-4288
Mailing Address - Fax:
Practice Address - Street 1:65 COMMONS WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1908
Practice Address - Country:US
Practice Address - Phone:503-784-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8188225700000X
MT18086225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist