Provider Demographics
NPI:1164926564
Name:JAZSA 5, LLC
Entity Type:Organization
Organization Name:JAZSA 5, LLC
Other - Org Name:287 THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OTR
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:STRODER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:903-874-6315
Mailing Address - Street 1:3728 S HWY 287
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75109-8960
Mailing Address - Country:US
Mailing Address - Phone:903-874-6315
Mailing Address - Fax:903-874-6387
Practice Address - Street 1:3728 S HWY 287
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75109-8960
Practice Address - Country:US
Practice Address - Phone:903-874-6315
Practice Address - Fax:903-874-6387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty