Provider Demographics
NPI:1508382532
Name:EGAN, JARED ANTHONY (PT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:ANTHONY
Last Name:EGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-3028
Mailing Address - Country:US
Mailing Address - Phone:520-868-0098
Mailing Address - Fax:520-868-1098
Practice Address - Street 1:1491 N ARIZONA BLVD STE 109
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85128-3261
Practice Address - Country:US
Practice Address - Phone:520-424-2222
Practice Address - Fax:520-424-2646
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist