Provider Demographics
NPI:1649401407
Name:MCKEE, JARED L (DPT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:L
Last Name:MCKEE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 E CHUBBUCK ROAD
Mailing Address - Street 2:STE A
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5055
Mailing Address - Country:US
Mailing Address - Phone:208-417-0011
Mailing Address - Fax:888-437-2431
Practice Address - Street 1:265 E CHUBBUCK ROAD
Practice Address - Street 2:STE A
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-5055
Practice Address - Country:US
Practice Address - Phone:208-417-0011
Practice Address - Fax:888-437-2431
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist