Provider Demographics
NPI:1215329560
Name:IVES, JARED (PT, DPT)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:IVES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 MUSICK RD
Mailing Address - Street 2:
Mailing Address - City:TOLAR
Mailing Address - State:TX
Mailing Address - Zip Code:76476-2019
Mailing Address - Country:US
Mailing Address - Phone:817-559-1004
Mailing Address - Fax:
Practice Address - Street 1:4601 MUSICK RD
Practice Address - Street 2:
Practice Address - City:TOLAR
Practice Address - State:TX
Practice Address - Zip Code:76476-2019
Practice Address - Country:US
Practice Address - Phone:817-559-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1246853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist