Healthcare Provider Details

I. General information

NPI: 1295656056
Provider Name (Legal Business Name): JARROD MCCANN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 CENTRAL AVE
RIVERSIDE CA
92506-2918
US

IV. Provider business mailing address

505 CALLE MONTECITO UNIT 27
OCEANSIDE CA
92057-5246
US

V. Phone/Fax

Practice location:
  • Phone: 951-222-2206
  • Fax:
Mailing address:
  • Phone: 951-222-2206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: