Healthcare Provider Details

I. General information

NPI: 1922584598
Provider Name (Legal Business Name): JAYWHY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 JOHNSON RD STE 204
KELLER TX
76248-3462
US

IV. Provider business mailing address

420 JOHNSON RD STE 204
KELLER TX
76248-3462
US

V. Phone/Fax

Practice location:
  • Phone: 817-431-4242
  • Fax:
Mailing address:
  • Phone: 817-431-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13106
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1264287
License Number StateTX

VIII. Authorized Official

Name: DR. FAN YANG
Title or Position: DOCTOR OF PHYSICAL THERAPY/OWNER
Credential: PT, DPT
Phone: 248-227-8904