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General NPI Number Information
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NPI Number | 1902113665
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Entity Type | Individual
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Provider Name | JODY FORCUM MMT
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Gender | Female
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 01/28/2019
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Provider Practice Location Address
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Address Line | 1120 S WALTON BLVD STE 104
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City | BENTONVILLE
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State | AR
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Zip | 72712-0075
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Country | US
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Telephone | 479-271-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 1907 S 9TH ST APT 213
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City | ROGERS
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State | AR
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Zip | 72758-6327
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Country | US
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Telephone | 794-295-1206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 6561
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License Number State | AR
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