Individual
JODI LYNN CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2401 41ST ST S, FARGO, ND 58104-7783
(701) 478-7868
Mailing address
500 CROSS ST, BIG STONE CITY, SD 57216-8237
(605) 541-1140
(218) 233-8545
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1288
ND
225100000X
Physical Therapist
6503
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
318295900
—
MN
05
—
55086
—
ND
Enumeration date
09/14/2006
Last updated
03/04/2022
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