Individual
JACK DYLAN NEAL WEBSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
15543 N REEMS RD STE 133, SURPRISE, AZ 85374-9582
(623) 975-5374
Mailing address
15410 S MOUNTAIN PKWY STE 112, PHOENIX, AZ 85044-6691
(217) 808-1913
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
31447
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26-2758436
PHYSICAL THERAPY
AZ
Enumeration date
09/03/2020
Last updated
09/03/2020
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