Provider Demographics
NPI:1508190091
Name:REESE, JAKESA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAKESA
Middle Name:
Last Name:REESE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 SOUTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8404
Mailing Address - Country:US
Mailing Address - Phone:870-897-8202
Mailing Address - Fax:
Practice Address - Street 1:1268 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7498
Practice Address - Country:US
Practice Address - Phone:479-750-1500
Practice Address - Fax:797-772-2800
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3186225100000X
ARPT3186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR3186OtherSTATE LIC