Provider Demographics
NPI:1215543046
Name:J.A.W. THERAPY LLC
Entity Type:Organization
Organization Name:J.A.W. THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGONA-WORDIE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:832-818-2751
Mailing Address - Street 1:714 55TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-6712
Mailing Address - Country:US
Mailing Address - Phone:832-818-2751
Mailing Address - Fax:
Practice Address - Street 1:714 55TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6712
Practice Address - Country:US
Practice Address - Phone:832-818-2751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC871597OtherPT LICENSE