Healthcare Provider Details

I. General information

NPI: 1861730004
Provider Name (Legal Business Name): JOCELYN DAROY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 IRONWOOD CIR
SOUTH BEND IN
46635-1888
US

IV. Provider business mailing address

3449 FIELD GATE DR
SOUTH BEND IN
46628-6125
US

V. Phone/Fax

Practice location:
  • Phone: 574-387-4049
  • Fax: 574-387-4062
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number05003525A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: