Organization
JUMPING JELLY BEANS PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON LEE GARDNER PT (PHYSICAL THERAPIST/OWNER)
(870) 919-0274
Entity
Organization
Contact information
Practice address
2319 E MATTHEWS AVE, JONESBORO, AR 72401-4415
(870) 919-0274
(870) 277-4335
Mailing address
2319 E MATTHEWS AVE, JONESBORO, AR 72401-4415
(870) 919-0274
(870) 277-4335
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 3047
AR
225X00000X
Occupational Therapist
OT 2329
AR
235Z00000X
Speech-Language Pathologist
SP 1873
AR
235Z00000X
Speech-Language Pathologist
SP 2878
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145147721
—
AR
05
—
167155721
—
AR
05
—
180139721
—
AR
05
—
180284721
—
AR
Enumeration date
09/02/2014
Last updated
09/12/2014
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