Active NPI
Jody Lynne Duda
- Physical Therapy Assistant
- Bartow, FL
National Provider Identifier
1194480871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 30233
- Practice address
- 2120 Marshall Edwards Dr
Bartow, FL 33830-6731 - Phone
- (863) 519-7579
- NPI assigned
- Nov 8, 2021
- 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 Therapy Assistant | 225200000X | 30233 | FL | Primary |
Addresses
Primary practice location
2120 Marshall Edwards Dr
Bartow, FL 33830-6731
Mailing address
15301 Palomapark LN
Lithia, FL 33547-4812
Phone (331) 642-2353
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 |
|---|---|---|---|
| 30233 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636329600000",
"number": "1194480871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15301 PALOMAPARK LN",
"city": "LITHIA",
"state": "FL",
"postal_code": "335474812",
"telephone_number": "331-642-2353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2120 MARSHALL EDWARDS DR",
"city": "BARTOW",
"state": "FL",
"postal_code": "338306731",
"telephone_number": "863-519-7579"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUDA",
"first_name": "JODY",
"middle_name": "LYNNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-08",
"last_updated": "2021-11-08",
"certification_date": "2021-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "30233",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bartow, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.