MEDICARE: JODI LYNN MEDELL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2509	NM

General Provider Information

NPI Number	:	1699807669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI LYNN MEDELL PT

Provider Business Mailing Address
First Line	:	PO BOX 154
Second Line	:
City	:	CRESTED BUTTE
State	:	CO
Zip	:	81224-0154
Country	:	US
Telephone Number	:	970-251-5462
Fax Number	:

Provider Business Practice Location Address
First Line	:	TREASURY CENTER 10
Second Line	:	CRESTED BUTTE WAY STE L2
City	:	MT. CRESTED BUTTE
State	:	CO
Zip	:	81225-0154
Country	:	US
Telephone Number	:	970-251-5462
Fax Number	:	970-251-5463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	02/05/2021

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