Provider Demographics
NPI:1417193905
Name:MAYFIELD, JAKARA ADRIAN (MPT)
Entity Type:Individual
Prefix:
First Name:JAKARA
Middle Name:ADRIAN
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JAKARA
Other - Middle Name:ADRIAN
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7400 HAVERFORD AVE
Mailing Address - Street 2:APT. E222
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2938
Mailing Address - Country:US
Mailing Address - Phone:610-609-6958
Mailing Address - Fax:610-237-5711
Practice Address - Street 1:1521 E BUSINESS 190
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2343
Practice Address - Country:US
Practice Address - Phone:254-238-7836
Practice Address - Fax:833-238-8515
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018674225100000X
TX1189273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist