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General NPI Number Information
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NPI Number | 1104607316
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Entity Type | Organization
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Legal Business Name | JG THERAPY LLC
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 2207 S WESTERN ST STE 110
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City | AMARILLO
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State | TX
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Zip | 79109-1572
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Country | US
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Telephone | 806-718-5399
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Fax | 806-718-6399
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Provider Business Mailing Address
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Address Line | PO BOX 32951
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City | AMARILLO
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State | TX
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Zip | 79120-2951
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Country | US
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Telephone | 806-718-5399
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Fax | 806-718-6399
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERRA GRAVES
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Credential | DPT
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Telephone | 505-362-4769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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