Provider Demographics
NPI:1215396742
Name:ARYEE, JEREMY (PT DPT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:ARYEE
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 STOCKER ST
Mailing Address - Street 2:APT 210
Mailing Address - City:VIEW PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5105
Mailing Address - Country:US
Mailing Address - Phone:781-510-6440
Mailing Address - Fax:
Practice Address - Street 1:3750 STOCKER ST
Practice Address - Street 2:APT 210
Practice Address - City:VIEW PARK
Practice Address - State:CA
Practice Address - Zip Code:90008-5105
Practice Address - Country:US
Practice Address - Phone:781-510-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist