Provider Demographics
NPI:1811683105
Name:JAYA PHYSICAL THERAPY
Entity type:Organization
Organization Name:JAYA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SUDANO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:919-793-3733
Mailing Address - Street 1:104 CABIN WOOD CT
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4671
Mailing Address - Country:US
Mailing Address - Phone:919-793-3733
Mailing Address - Fax:
Practice Address - Street 1:2680 IMPULSION DR
Practice Address - Street 2:
Practice Address - City:NEW HILL
Practice Address - State:NC
Practice Address - Zip Code:27562-9344
Practice Address - Country:US
Practice Address - Phone:919-793-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy