Individual provider Active NPI

Jody M Allen, DPT

  • Physical Therapist
  • Vancouver, WA
National Provider Identifier
1104548197
Registry record updated Mar 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
61352735 Issued in WA
Practice address
501 SE 172ND Ave # 110
Vancouver, WA 98684-9542
Phone
(360) 329-4836
NPI assigned
Sep 15, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1365131 TX
Physical Therapist 225100000X 61352735 WA Primary

Addresses

Primary practice location

501 SE 172ND Ave # 110
Vancouver, WA 98684-9542

Mailing address

PO Box 4825
Portland, OR 97208-4825

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221207000638 WA Practitioner - Physical Therapist in Private Practice 0345619755 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Vancouver Clinic Inc PSGroup PAC ID 3173436490, 580 clinicians

Practice addresses (Care Compare)

501 SE 172ND Ave
Vancouver, WA 98684-9542
Phone (360) 882-2778

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1365131TXMDPhysical Therapist
61352735WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
The Vancouver Clinic Inc PS CurrentSince Dec 5, 2022 Accepting new patients
The Vancouver Clinic Inc PS CurrentSince Dec 5, 2022 Accepting new patients
The Vancouver Clinic Pharmacy Past Accepting new patients

Locations

501 SE 172nd Ave
#110
Vancouver, WA 98684
Phone (360) 329-4836

501 SE 172nd Ave
Vancouver, WA 98684

700 NE 87th Ave
Vancouver, WA 98664
Phone (360) 397-1500

501 SE 172nd Ave
Ste 110
Vancouver, WA 98684

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1663200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1104548197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4825",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972084825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 SE 172ND AVE # 110",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986849542",
            "telephone_number": "360-329-4836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "JODY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-15",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1365131",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "61352735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.