Provider Demographics
NPI:1255334694
Name:TENNEY, JARED (PT, MPT)
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:
Last Name:TENNEY
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 E STATE HIGHWAY 260
Mailing Address - Street 2:STE 1
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4972
Mailing Address - Country:US
Mailing Address - Phone:928-474-0429
Mailing Address - Fax:928-474-0199
Practice Address - Street 1:903 E STATE HIGHWAY 260
Practice Address - Street 2:STE 1
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4972
Practice Address - Country:US
Practice Address - Phone:928-474-0429
Practice Address - Fax:928-474-0199
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0295990OtherBCBS AZ
AZ545098Medicaid
AZF02383Medicaid
AZ1Z6798OtherHEALTH NET
AZ64-00187OtherUNITED HEALTH PLAN
AZ545098Medicaid
AZF02383Medicaid
AZZ60765Medicare ID - Type Unspecified