Provider Demographics
NPI:1972008928
Name:TASKER, JAY (PTA)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:TASKER
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 1:1056 MEADOW SCAPE DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-1799
Mailing Address - Country:US
Mailing Address - Phone:940-366-3040
Mailing Address - Fax:
Practice Address - Street 1:1056 MEADOW SCAPE DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-1799
Practice Address - Country:US
Practice Address - Phone:940-366-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2113235225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant