Provider Demographics
NPI:1366631848
Name:JERL, INC.
Entity Type:Organization
Organization Name:JERL, INC.
Other - Org Name:KETHLEY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KETHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:512-858-5191
Mailing Address - Street 1:PO BOX 562
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-0562
Mailing Address - Country:US
Mailing Address - Phone:512-858-5191
Mailing Address - Fax:512-858-5194
Practice Address - Street 1:800 W HIGHWAY 290
Practice Address - Street 2:BLDG. B, SUITE 300
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4191
Practice Address - Country:US
Practice Address - Phone:512-858-5191
Practice Address - Fax:512-858-5194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658770000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy