Provider Demographics
NPI:1275979239
Name:JARABEK, JACQUELINE M (MPT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:JARABEK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:M
Other - Last Name:DAHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:18170 N 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-0866
Mailing Address - Country:US
Mailing Address - Phone:623-374-6660
Mailing Address - Fax:
Practice Address - Street 1:18170 N 91ST AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-0866
Practice Address - Country:US
Practice Address - Phone:623-374-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist