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General NPI Number Information
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NPI Number | 1578298022
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Entity Type | Individual
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Provider Name | KADARIUS JACK DPT
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Gender | Male
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 06/14/2025
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Provider Practice Location Address
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Address Line | 13690 HIGHWAY 51 S STE 104
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City | ATOKA
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State | TN
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Zip | 38004-7645
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Country | US
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Telephone | 901-259-4254
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Fax | 901-725-8353
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Provider Business Mailing Address
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Address Line | 13690 HIGHWAY 51 S STE 104
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City | ATOKA
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State | TN
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Zip | 38004-7645
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Country | US
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Telephone | 901-259-4254
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Fax | 901-725-8353
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 16552
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License Number State | TN
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