Provider Demographics
NPI:1407555758
Name:JAG HEALTH, LLC
Entity Type:Organization
Organization Name:JAG HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:763-299-5677
Mailing Address - Street 1:13640 OLIVIA CT
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-9381
Mailing Address - Country:US
Mailing Address - Phone:763-299-5677
Mailing Address - Fax:
Practice Address - Street 1:13640 OLIVIA CT
Practice Address - Street 2:
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-9381
Practice Address - Country:US
Practice Address - Phone:763-299-5677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty