Provider Demographics
NPI:1275559437
Name:JAY REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:JAY REHABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAYANT
Authorized Official - Middle Name:V
Authorized Official - Last Name:MAHURE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:417-438-3467
Mailing Address - Street 1:2610 SOUTH OZARK AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3182
Mailing Address - Country:US
Mailing Address - Phone:417-659-9948
Mailing Address - Fax:417-659-8800
Practice Address - Street 1:2610 SOUTH OZARK AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3182
Practice Address - Country:US
Practice Address - Phone:417-659-9948
Practice Address - Fax:417-659-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105033225100000X
KS1102030225100000X
MO2004823996225100000X
KS1102995225100000X
MO004581225X00000X
KS989520225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201302OtherBCBS
DD3427OtherMEDICARE RAILROAD
A002OtherTRICARE
A002OtherTRICARE