MEDICARE: BRIAN JOVAG PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	111894	MO

General Provider Information

NPI Number	:	1134189079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN JOVAG PT, DPT

Provider Business Mailing Address
First Line	:	704 7TH AVE SW
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98371-6769
Country	:	US
Telephone Number	:	253-376-4030
Fax Number	:

Provider Business Practice Location Address
First Line	:	9040 JACKSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-5318
Country	:	US
Telephone Number	:	253-968-2252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	04/28/2020

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