Provider Demographics
NPI:1295023612
Name:MCSPADDEN, JEREMY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:MCSPADDEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 RUFE SNOW DR STE 110
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6021
Mailing Address - Country:US
Mailing Address - Phone:817-345-4367
Mailing Address - Fax:254-249-1566
Practice Address - Street 1:5121 RUFE SNOW DR STE 110
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6021
Practice Address - Country:US
Practice Address - Phone:817-345-4367
Practice Address - Fax:254-249-1566
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1207686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist