Provider Demographics
NPI:1588993463
Name:PARIS, JEFF DWAYNE (PTA)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:DWAYNE
Last Name:PARIS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4956 ONSLOW CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-7507
Mailing Address - Country:US
Mailing Address - Phone:317-887-0005
Mailing Address - Fax:
Practice Address - Street 1:4956 ONSLOW CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-7507
Practice Address - Country:US
Practice Address - Phone:317-887-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001258A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant