Healthcare Provider Details

I. General information

NPI: 1699692236
Provider Name (Legal Business Name): JODY THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 S STATE ROAD 7
WELLINGTON FL
33414-6135
US

IV. Provider business mailing address

13466 OLD ENGLISHTOWN RD
WELLINGTON FL
33414-3993
US

V. Phone/Fax

Practice location:
  • Phone: 561-301-8562
  • Fax:
Mailing address:
  • Phone: 561-301-8562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA105636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: