Provider Demographics
NPI:1780041269
Name:ANCER, JAY
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:ANCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FIANNA WAY
Mailing Address - Street 2:MAIL DROP 2761
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72919-2761
Mailing Address - Country:US
Mailing Address - Phone:877-823-8375
Mailing Address - Fax:
Practice Address - Street 1:2110 FLEISCHMANN RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0562
Practice Address - Country:US
Practice Address - Phone:229-460-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist