Provider Demographics
NPI:1487135281
Name:STOJAKOVICH, JEREMY JASON (PT, DPT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:JASON
Last Name:STOJAKOVICH
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 1:1015 GRANADA AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3427
Mailing Address - Country:US
Mailing Address - Phone:253-831-2254
Mailing Address - Fax:
Practice Address - Street 1:5380 HICKORY HOLLOW PKWY STE 201
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3389
Practice Address - Country:US
Practice Address - Phone:615-891-2070
Practice Address - Fax:615-891-2056
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60863095225100000X
TN12537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist