Active NPI
Jodi Bandola, P.T.
- Physical Therapist
- Brockton, MA
National Provider Identifier
1417114661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 17507
- Practice address
- 110 Liberty St
Suite 1300
Brockton, MA 02301-5521 - Phone
- (508) 580-0144
- Fax
- (508) 580-0449
- NPI assigned
- May 16, 2008
- 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 | 17507 | MA | Primary |
Addresses
Primary practice location
110 Liberty St
Suite 1300
Brockton, MA 02301-5521
Mailing address
322 E Center St
West Bridgewater, MA 02379-1824
Phone (508) 559-0993
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 |
|---|---|---|---|
| 17507 | MA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fitness Forum Services LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Brockton, MA
- NPI 1205803558
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210896000000",
"number": "1417114661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "322 E CENTER ST",
"city": "WEST BRIDGEWATER",
"state": "MA",
"postal_code": "023791824",
"telephone_number": "508-559-0993",
"fax_number": "508-559-5072"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 LIBERTY ST",
"address_2": "SUITE 1300",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023015521",
"telephone_number": "508-580-0144",
"fax_number": "508-580-0449"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANDOLA",
"first_name": "JODI",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-16",
"last_updated": "2008-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "17507",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.