Organization Name: | JERL, INC. |
NPI Number: | 1366631848 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JEREMY L. KETHLEY (PRESIDENT) |
Mailing Address: | 800 W Highway 290 Bldg. B, Suite 300 Dripping Springs |
State: | TX US |
Postal Code: | 786204191 |
Phone Number: | 5128585191 |
Fax Number: | 5128585194 |
NPI Enumeration Date: | 10/19/2007 |
NPI Last Update Date: | 07/12/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | 658770000 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |