Provider Demographics
NPI:1851679997
Name:VERTREES, JACK (PT)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:VERTREES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7065 N MAPLE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8013
Mailing Address - Country:US
Mailing Address - Phone:559-299-9989
Mailing Address - Fax:559-299-9979
Practice Address - Street 1:7065 N MAPLE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8013
Practice Address - Country:US
Practice Address - Phone:559-299-9989
Practice Address - Fax:559-299-9979
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist