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General NPI Number Information
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NPI Number | 1821375189
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Entity Type | Organization
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Legal Business Name | JKD THERAPY & BODY WERX LLC
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 1140 INDIANAPOLIS RD
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City | GREENCASTLE
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State | IN
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Zip | 46135-1458
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Country | US
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Telephone | 765-247-4901
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Fax | 765-246-4088
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Provider Business Mailing Address
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Address Line | PO BOX 923
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City | GREENCASTLE
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State | IN
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Zip | 46135-0923
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Country | US
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Telephone | 765-247-4901
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Fax | 765-246-4088
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Authorized Official
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Title or Position | CO-OWNER, JKD THERAPY & BODY WERX L
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Name | MRS. JANNA LEE KISSEL
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Credential | PT
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Telephone | 765-247-4901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 05006979A
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License Number State | IN
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