Provider Demographics
NPI:1326422304
Name:FLETCHER, JARED MARK (DPT, MOT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:MARK
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:DPT, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 HEALTH PARK STE 127
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4731
Mailing Address - Country:US
Mailing Address - Phone:321-749-3690
Mailing Address - Fax:
Practice Address - Street 1:3700 NW CARY PKWY STE 110
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8446
Practice Address - Country:US
Practice Address - Phone:321-749-3690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-19
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209388225100000X
FLOT16107225X00000X
NCP157342251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist