Provider Demographics
NPI:1144851387
Name:FODGE, JOSLYN (LMT)
Entity type:Individual
Prefix:
First Name:JOSLYN
Middle Name:
Last Name:FODGE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482A MIDDLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:12850-1108
Mailing Address - Country:US
Mailing Address - Phone:518-366-6470
Mailing Address - Fax:
Practice Address - Street 1:70 RAILROAD PL STE 101A
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-3058
Practice Address - Country:US
Practice Address - Phone:518-366-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029345-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist