Provider Demographics
NPI:1386920940
Name:JETT, ARIE (PTA)
Entity type:Individual
Prefix:
First Name:ARIE
Middle Name:
Last Name:JETT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S MAIN ST STE 500
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3659
Mailing Address - Country:US
Mailing Address - Phone:901-312-5600
Mailing Address - Fax:901-312-5643
Practice Address - Street 1:119 S MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3659
Practice Address - Country:US
Practice Address - Phone:901-312-5600
Practice Address - Fax:901-312-5643
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3706225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant