Healthcare Provider Details

I. General information

NPI: 1265941942
Provider Name (Legal Business Name): JARED RYAN CAVE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S WISTERIA ST
MANSFIELD TX
76063
US

IV. Provider business mailing address

6852 SEACOAST DR
GRAND PRAIRIE TX
75054-6827
US

V. Phone/Fax

Practice location:
  • Phone: 325-207-4704
  • Fax:
Mailing address:
  • Phone: 325-207-4704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1293208
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: