Healthcare Provider Details

I. General information

NPI: 1679818108
Provider Name (Legal Business Name): JADE ELYSE METCALF PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 RESEARCH BLVD STE 2-350
AUSTIN TX
78759-6586
US

IV. Provider business mailing address

3772 MISSION AVE SUITE 122
OCEANSIDE CA
92058-1453
US

V. Phone/Fax

Practice location:
  • Phone: 512-710-6516
  • Fax: 512-355-1966
Mailing address:
  • Phone: 760-630-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number39618
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1329913
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: