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Individual
JARA DUBOSE
Active
Individual
JARA DUBOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1115020
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220122001
—
TX
05
—
220122002
—
TX
01
—
540044100
FIRSTCARE
TX
01
—
849T44
BLUE CROSS BLUE SHIELD
TX
01
—
P01108866
MEDICARE RAILROAD
TX
Enumeration date
09/21/2010
Last updated
01/09/2013
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