Healthcare Provider Details

I. General information

NPI: 1912946435
Provider Name (Legal Business Name): JASE JARED PINEROLA P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5796 NASHVILLE RD
BOWLING GREEN KY
42101-7546
US

IV. Provider business mailing address

922 KENSINGTON WAY
BOWLING GREEN KY
42103-0921
US

V. Phone/Fax

Practice location:
  • Phone: 270-745-0987
  • Fax:
Mailing address:
  • Phone: 270-535-6858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 001927
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberPT001927
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: