Provider Demographics
NPI:1457553679
Name:FAUL, JARED SCOTT IX
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:SCOTT
Last Name:FAUL
Suffix:IX
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 1:2685 SW 32ND PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7162
Mailing Address - Country:US
Mailing Address - Phone:352-629-0033
Mailing Address - Fax:352-629-0072
Practice Address - Street 1:2685 SW 32ND PL
Practice Address - Street 2:SUITE 200
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7162
Practice Address - Country:US
Practice Address - Phone:352-629-0033
Practice Address - Fax:352-629-0072
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23393225100000X
FLOT12706225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist