Provider Demographics
NPI:1750440301
Name:JET PT PC
Entity type:Organization
Organization Name:JET PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:P T
Authorized Official - Phone:319-653-5494
Mailing Address - Street 1:511 HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-9782
Mailing Address - Country:US
Mailing Address - Phone:319-653-5494
Mailing Address - Fax:319-863-9016
Practice Address - Street 1:511 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-9782
Practice Address - Country:US
Practice Address - Phone:319-653-5494
Practice Address - Fax:319-863-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01219225X00000X
IA00346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI15761Medicare ID - Type Unspecified
IAI15760Medicare PIN
IAI20849Medicare PIN
IAI15763Medicare ID - Type Unspecified