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General NPI Number Information
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NPI Number | 1205318672
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Entity Type | Individual
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Provider Name | JONATHAN D JETT
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Gender | Male
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Dates
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Enumeration Date | 09/03/2018
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Last Update Date | 09/03/2018
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Provider Practice Location Address
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Address Line | 1301 E QUEBEC AVE
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City | MCALLEN
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State | TX
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Zip | 78503-1623
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Country | US
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Telephone | 956-661-4300
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Fax | 956-664-9065
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Provider Business Mailing Address
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Address Line | 1205 HUMMINGBIRD DR
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City | PHARR
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State | TX
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Zip | 78577-2361
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Country | US
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Telephone | 956-342-3783
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Fax | 956-664-9065
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2083921
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License Number State | TX
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