Prairie Ridge Orthopedic

Primary specialty

Massage TherapistTaxonomy code 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

Last updated

Nov 15, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jody Hazel, LMTNPI 1093314148

Title

Therapist

Phone

(618) 302-1703

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jody Lee Hazel, LMT

  • Massage Therapist
  • Noble, IL
  • NPI 1093314148

  Single Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668470400000",
    "number": "1033718192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 E COLBORN CAMP LN",
            "city": "NOBLE",
            "state": "IL",
            "postal_code": "628682348",
            "telephone_number": "618-302-1703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 E COLBORN CAMP LN",
            "city": "NOBLE",
            "state": "IL",
            "postal_code": "628682348",
            "telephone_number": "618-302-1703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE RIDGE ORTHOPEDIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-20",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A",
        "authorized_official_last_name": "HAZEL",
        "authorized_official_first_name": "JODY",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "618-302-1703",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Correll, PTA
• Jody Lee Hazel, LMT
• Ink & Ivy Psychiatry PLLC
• Cynthia Dawn Klingler, DT
• Kelsey Lynn Lee
• Karen Seals, OTR/L
• Christopher Spenner
• Jacklyn Kay Stanley, APRN, PMHNP-BC
• Maria L Totten
• West Richland Cusd No 2

• Massage Therapist in Noble, IL
• Providers in Noble, IL by specialty
• Massage Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.