=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831977966
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JARRED NEWMYER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2023
-----------------------------------------------------
Last Update Date | 09/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 E WASHINGTON ST
-----------------------------------------------------
City | MEDINA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44256-2170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-721-5313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 770 US HIGHWAY 42
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44805-9515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-543-1783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Y00000X
-----------------------------------------------------
Taxonomy Name | Clinical Exercise Physiologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------