Provider Demographics
NPI:1235239625
Name:JAD THERAPY LLC
Entity Type:Organization
Organization Name:JAD THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:DERRENBACKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:352-563-2407
Mailing Address - Street 1:P.O. BOX 2154
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34423
Mailing Address - Country:US
Mailing Address - Phone:352-563-2407
Mailing Address - Fax:352-563-2807
Practice Address - Street 1:1669 SE HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429
Practice Address - Country:US
Practice Address - Phone:352-563-2407
Practice Address - Fax:352-563-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 0006090261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty