Provider Demographics
NPI:1740599638
Name:ALLBRIGHT, JACE ALAN (PT DPT CSCS)
Entity Type:Individual
Prefix:
First Name:JACE
Middle Name:ALAN
Last Name:ALLBRIGHT
Suffix:
Gender:M
Credentials:PT DPT CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:951-335-9825
Mailing Address - Fax:951-666-5096
Practice Address - Street 1:3505 MADISON ST STE 102
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3785
Practice Address - Country:US
Practice Address - Phone:951-329-3928
Practice Address - Fax:951-374-0621
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 37176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0271234OtherSTATE OF WASHINGTON DEPT. OF LABOR AND INDUSTRIES
CA0PT371760OtherBLUE SHIELD OF CALIFORNIA
CAEG383ZMedicare PIN