Individual
JODI WADGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
601 S WESTWOOD AVE, KINGSFORD, MI 49802-1109
(906) 779-1880
(906) 779-0818
Mailing address
601 S WESTWOOD AVE, KINGSFORD, MI 49802-1109
(906) 779-1880
(906) 779-0818
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501005505
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0B20009
BLUE CROSS BLUE SHIELD
MI
Enumeration date
02/21/2007
Last updated
05/16/2008
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