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NPI Code Detail

MEDICARE: JAKESA REESE PT, DPT

MEDICARE: JAKESA REESE 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
1225100000XPhysical Therapist3186AR
2225100000XPhysical TherapistPT3186AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13186OTHERARSTATE LIC

General Provider Information

NPI Number : 1508190091
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAKESA REESE PT, DPT
Provider Business Mailing Address
First Line : 3127 SOUTHWEST DR
Second Line :
City : JONESBORO
State : AR
Zip : 72404-8404
Country : US
Telephone Number : 870-897-8202
Fax Number :
Provider Business Practice Location Address
First Line : 1268 ELECTRIC AVE
Second Line :
City : SPRINGDALE
State : AR
Zip : 72764-7498
Country : US
Telephone Number : 479-750-1500
Fax Number : 797-772-2800
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2009
Last Update Date : 05/18/2023

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