Provider Demographics
NPI:1548411788
Name:JASPER PHYSICAL THERAPY AND REHAB CENTER LLC
Entity Type:Organization
Organization Name:JASPER PHYSICAL THERAPY AND REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-965-8665
Mailing Address - Street 1:2324 S CONGRESS AVE
Mailing Address - Street 2:SUITE 1 J
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7669
Mailing Address - Country:US
Mailing Address - Phone:561-965-8665
Mailing Address - Fax:561-965-2760
Practice Address - Street 1:1037 STATE ROAD #7
Practice Address - Street 2:SUITE #302
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-965-8665
Practice Address - Fax:561-965-2760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy