Prairie Ridge Orthopedic – Massage Therapist

Key facts

NPI: 1033718192
Entity type: Organization (NPI type 2)
Primary specialty: Massage Therapist 225700000X
Legal business name: PRAIRIE RIDGE ORTHOPEDIC
Practice address: 1750 E Colborn Camp LN
Noble, IL 62868-2348
Phone: (618) 302-1703
NPI assigned: Oct 20, 2020
Organization subpart: No

Authorized official

Name: Jody Hazel, LMT NPI 1093314148
Title: Therapist
Phone: (618) 302-1703

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Jody Lee Hazel, LMT Massage Therapist · Noble, IL · NPI 1093314148

NPD Authorized official SINGLE SPECIALTY

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Massage Therapist Group: 193400000X SINGLE SPECIALTY GROUP	225700000X			Yes

Addresses

Primary practice location

1750 E Colborn Camp LN
Noble, IL 62868-2348

Mailing address

1750 E Colborn Camp LN
Noble, IL 62868-2348
Phone (618) 302-1703

Other providers in Noble, IL

All providers in Noble, IL · Massage Therapist in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.