Provider Demographics
NPI:1407952435
Name:PAULY, JONATHAN ROBERT (MPT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ROBERT
Last Name:PAULY
Suffix:
Gender:M
Credentials:MPT
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Mailing Address - Street 1:PO BOX 6854
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6854
Mailing Address - Country:US
Mailing Address - Phone:480-250-4741
Mailing Address - Fax:480-840-1404
Practice Address - Street 1:1370 W SARAGOSA PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-7216
Practice Address - Country:US
Practice Address - Phone:480-250-4741
Practice Address - Fax:480-840-1404
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ54402251G0304X, 2251H1300X, 2251N0400X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251H1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHuman Factors
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ113852Medicare PIN