Provider Demographics
NPI:1124201686
Name:JARO, MARY KRISTINE (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KRISTINE
Last Name:JARO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15404 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2223
Mailing Address - Country:US
Mailing Address - Phone:310-408-9828
Mailing Address - Fax:
Practice Address - Street 1:10959 ROCHESTER AVE
Practice Address - Street 2:APT. 506
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-7703
Practice Address - Country:US
Practice Address - Phone:310-408-9828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist