Provider Demographics
NPI:1528188158
Name:WEXLER, JAY I (PT)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:I
Last Name:WEXLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:WEXLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2904 ELLESMERE AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3609
Mailing Address - Country:US
Mailing Address - Phone:714-432-1877
Mailing Address - Fax:714-432-1877
Practice Address - Street 1:4655 RUFFNER ST
Practice Address - Street 2:SUITE 270
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2275
Practice Address - Country:US
Practice Address - Phone:800-787-6787
Practice Address - Fax:800-787-6762
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT3586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist