Healthcare Provider Details

I. General information

NPI: 1770096596
Provider Name (Legal Business Name): JARROD KEY LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 ROSS CARTER BLVD
DUFFIELD VA
24244-5116
US

IV. Provider business mailing address

157 ROSS CARTER BLVD
DUFFIELD VA
24244
US

V. Phone/Fax

Practice location:
  • Phone: 276-431-2841
  • Fax: 276-431-4718
Mailing address:
  • Phone: 276-431-2841
  • Fax: 276-431-4718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberCP007619A
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306604789
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: