Provider Demographics
NPI:1760795645
Name:STRAUB, JARED RYAN (PT, DPT, AT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:RYAN
Last Name:STRAUB
Suffix:
Gender:M
Credentials:PT, DPT, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8630 E VIA DE VENTURA
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3326
Mailing Address - Country:US
Mailing Address - Phone:480-656-8808
Mailing Address - Fax:480-664-8659
Practice Address - Street 1:8630 E VIA DE VENTURA
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3326
Practice Address - Country:US
Practice Address - Phone:480-656-8808
Practice Address - Fax:480-664-8659
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist