Healthcare Provider Details

I. General information

NPI: 1558390963
Provider Name (Legal Business Name): JODY LYNN BARLOW P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 HAMACHER ST
WATERLOO IL
62298-1592
US

IV. Provider business mailing address

15 APEX DR
HIGHLAND IL
62249-1282
US

V. Phone/Fax

Practice location:
  • Phone: 618-939-5555
  • Fax: 618-939-3424
Mailing address:
  • Phone: 618-441-0482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number070011845
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: