Provider Demographics
NPI:1518626654
Name:JET PHYSIO SPORTS PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:JET PHYSIO SPORTS PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYUG
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:415-237-3017
Mailing Address - Street 1:3020 BRIDGEWAY
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1439
Mailing Address - Country:US
Mailing Address - Phone:415-237-3017
Mailing Address - Fax:628-234-3054
Practice Address - Street 1:3020 BRIDGEWAY
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1439
Practice Address - Country:US
Practice Address - Phone:415-237-3017
Practice Address - Fax:628-234-3054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy