Provider Demographics
NPI:1447278460
Name:SICKELS, JODI A (PT)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:A
Last Name:SICKELS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5244
Mailing Address - Fax:740-446-5448
Practice Address - Street 1:1051 4TH AVE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631
Practice Address - Country:US
Practice Address - Phone:740-446-5244
Practice Address - Fax:740-446-5448
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH005681225100000X
WV002095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
650019672OtherRR MEDICARE
OH2222517OtherMOLINA MEDICAID
310917085343OtherMOUNTAIN STATE BCBS
000000217353OtherANTHEM BCBS
WV0156655000Medicaid
OH2222517Medicaid
000000204797OtherOH MEDICAID UNISON
WV0156655000Medicaid