Organization
PRAIRIE RIDGE ORTHOPEDIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODY HAZEL LMT (THERAPIST)
(618) 302-1703
Entity
Organization
Contact information
Practice address
1750 E COLBORN CAMP LN, NOBLE, IL 62868-2348
(618) 302-1703
Mailing address
1750 E COLBORN CAMP LN, NOBLE, IL 62868-2348
(618) 302-1703
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
10/20/2020
Last updated
11/15/2022
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