Provider Demographics
NPI:1528044302
Name:JARRETT, CHAD (PT)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:JARRETT
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 1:2651 IRVINE AVE
Mailing Address - Street 2:SUITE 128
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-4628
Mailing Address - Country:US
Mailing Address - Phone:949-722-8811
Mailing Address - Fax:
Practice Address - Street 1:2651 IRVINE AVE
Practice Address - Street 2:SUITE 128
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4628
Practice Address - Country:US
Practice Address - Phone:949-722-8811
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT22363BMedicare ID - Type UnspecifiedPPIN