Provider Demographics
NPI:1184981318
Name:SPRUTE, JACOB RAY (DPT)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:RAY
Last Name:SPRUTE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W GLENEAGLES DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-5254
Mailing Address - Country:US
Mailing Address - Phone:509-280-4474
Mailing Address - Fax:
Practice Address - Street 1:413 E TREMAINE AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-4623
Practice Address - Country:US
Practice Address - Phone:602-295-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ94452251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics