Provider Demographics
NPI:1235591272
Name:DESCOTEAUX, JARED (DPT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:DESCOTEAUX
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 CASA VERDE ST
Mailing Address - Street 2:APT 2320
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-3322
Mailing Address - Country:US
Mailing Address - Phone:509-710-5281
Mailing Address - Fax:
Practice Address - Street 1:5980 STONERIDGE DR
Practice Address - Street 2:#100
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4518
Practice Address - Country:US
Practice Address - Phone:925-847-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist