Provider Demographics
NPI:1013589670
Name:MERRILL, JAYSON BRYANT (DPT)
Entity Type:Individual
Prefix:DR
First Name:JAYSON
Middle Name:BRYANT
Last Name:MERRILL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 COWELL RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-1443
Mailing Address - Country:US
Mailing Address - Phone:925-876-9872
Mailing Address - Fax:
Practice Address - Street 1:3355 COWELL RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-1443
Practice Address - Country:US
Practice Address - Phone:925-876-9872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361362251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1013589670Medicaid