Provider Demographics
NPI:1740746056
Name:AMIOT, JARED CHRISTOPHER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:CHRISTOPHER
Last Name:AMIOT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 NELSON RD STE 500
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2440
Mailing Address - Country:US
Mailing Address - Phone:337-494-7546
Mailing Address - Fax:
Practice Address - Street 1:4080 NELSON RD STE 500
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2440
Practice Address - Country:US
Practice Address - Phone:337-494-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10210208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA10210OtherLOUISIANA PT BOARD