Provider Demographics
NPI:1114980695
Name:ELDRIDGE, JAY (PT)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6384
Mailing Address - Country:US
Mailing Address - Phone:928-726-5000
Mailing Address - Fax:
Practice Address - Street 1:901 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6384
Practice Address - Country:US
Practice Address - Phone:928-726-5000
Practice Address - Fax:928-344-3614
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0293620OtherBLUE CROSS OF AZ
AZ650021638OtherRAILROAD MEDICARE
AZAZ0293620OtherBLUE CROSS OF AZ