Provider Demographics
NPI:1750119210
Name:THACKER, JARED (DPT)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:THACKER
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 1:16040 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-9752
Mailing Address - Country:US
Mailing Address - Phone:740-972-3024
Mailing Address - Fax:
Practice Address - Street 1:4531 COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:CENTERBURG
Practice Address - State:OH
Practice Address - Zip Code:43011-9401
Practice Address - Country:US
Practice Address - Phone:740-625-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist