Provider Demographics
NPI:1467599035
Name:JWG, INC
Entity Type:Organization
Organization Name:JWG, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-321-1698
Mailing Address - Street 1:844 N. ELLSWORTH
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-5114
Mailing Address - Country:US
Mailing Address - Phone:480-380-2810
Mailing Address - Fax:480-380-2861
Practice Address - Street 1:844 N. ELLSWORTH
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-5114
Practice Address - Country:US
Practice Address - Phone:480-380-2810
Practice Address - Fax:480-380-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0298870OtherBCBS