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NPI Code Detail

MEDICARE: JARED KING PTA

MEDICARE: JARED KING PTA
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
1225200000XPhysical Therapy Assistant5193TN

General Provider Information

NPI Number : 1609300938
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARED KING PTA
Provider Business Mailing Address
First Line : 5010 TROTWOOD AVE
Second Line :
City : COLUMBIA
State : TN
Zip : 38401-5074
Country : US
Telephone Number : 931-398-6300
Fax Number :
Provider Business Practice Location Address
First Line : 5010 TROTWOOD AVE
Second Line :
City : COLUMBIA
State : TN
Zip : 38401-5074
Country : US
Telephone Number : 931-398-6300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2017
Last Update Date : 04/13/2017

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