Provider Demographics
NPI:1629651237
Name:JAY WEST PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:JAY WEST PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-916-6746
Mailing Address - Street 1:362 EUCLID AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3239
Mailing Address - Country:US
Mailing Address - Phone:201-916-6746
Mailing Address - Fax:
Practice Address - Street 1:6125 MEDAU PL
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2808
Practice Address - Country:US
Practice Address - Phone:201-916-6746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-01
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1376922336Medicaid