Provider Demographics
NPI:1750111613
Name:DAUER, JARED JEREMY (DPT)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:JEREMY
Last Name:DAUER
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 1:221 W FIR AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-0223
Mailing Address - Country:US
Mailing Address - Phone:559-325-3444
Mailing Address - Fax:559-325-7444
Practice Address - Street 1:221 W FIR AVE STE 105
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-0223
Practice Address - Country:US
Practice Address - Phone:559-325-3444
Practice Address - Fax:559-325-7444
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT306469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist