Individual
JODIE HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, ATC, CSCS
Contact information
Practice address
111 BREWSTER ST, PAWTUCKET, RI 02860-4474
(401) 729-2316
Mailing address
PO BOX 61, SEEKONK, MA 02771
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
10872
MA
225100000X
Physical Therapist
Primary
—
RI
2251S0007X
Sports Physical Therapist
10872
MA
2251X0800X
Orthopedic Physical Therapist
10872
MA
2255A2300X
Athletic Trainer
AT916
MA
246ZA2600X
Medical Art Specialist/Technologist
—
—
Other
Enumeration date
11/24/2008
Last updated
05/19/2016
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