Provider Demographics
NPI:1871082800
Name:MOWERY, JODY MARIE
Entity type:Individual
Prefix:MR
First Name:JODY
Middle Name:MARIE
Last Name:MOWERY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JODY
Other - Middle Name:MARIE
Other - Last Name:SPEIDEL-MOWERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3030 NW EXPRESSWAY STE 809
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5466
Mailing Address - Country:US
Mailing Address - Phone:405-917-7160
Mailing Address - Fax:405-917-7161
Practice Address - Street 1:3030 NW EXPRESSWAY STE 809
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5466
Practice Address - Country:US
Practice Address - Phone:405-917-7160
Practice Address - Fax:405-917-7161
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1331225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant