Provider Demographics
NPI:1922497486
Name:MCALISTER, JEROMY (CPTA, MS)
Entity Type:Individual
Prefix:
First Name:JEROMY
Middle Name:
Last Name:MCALISTER
Suffix:
Gender:M
Credentials:CPTA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 E 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-5615
Mailing Address - Country:US
Mailing Address - Phone:620-960-3295
Mailing Address - Fax:
Practice Address - Street 1:1019 E 21ST AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-5615
Practice Address - Country:US
Practice Address - Phone:620-960-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02241225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant