Active NPI
Jennifer L Rodabough, PT
- Physical Therapist
- Tupelo, MS
National Provider Identifier
1083858229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT2985
- Practice address
- 2089 Southridge Dr
Tupelo, MS 38801-6478 - Phone
- (662) 407-0801
- Fax
- (662) 407-0807
- NPI assigned
- Apr 30, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT2985 | MS | Primary |
Addresses
Primary practice location
2089 Southridge Dr
Tupelo, MS 38801-6478
Mailing address
PO Box 11407
Birmingham, AL 35246-1218
Phone (800) 897-6169
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT2985 | MS | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241049600000",
"number": "1083858229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 11407",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352461218",
"telephone_number": "800-897-6169",
"fax_number": "800-897-6170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2089 SOUTHRIDGE DR",
"city": "TUPELO",
"state": "MS",
"postal_code": "388016478",
"telephone_number": "662-407-0801",
"fax_number": "662-407-0807"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODABOUGH",
"first_name": "JENNIFER",
"middle_name": "L",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-04-30",
"last_updated": "2009-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MS",
"license": "PT2985",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tupelo, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.