Provider Demographics
NPI:1053498014
Name:DEJAGER, JANWOUT
Entity Type:Individual
Prefix:
First Name:JANWOUT
Middle Name:
Last Name:DEJAGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14546 RIVER FOREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-6520
Mailing Address - Country:US
Mailing Address - Phone:281-870-9336
Mailing Address - Fax:
Practice Address - Street 1:810 S MASON RD STE 101
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3857
Practice Address - Country:US
Practice Address - Phone:281-392-7811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1143600OtherLICENSE#