Basic Information
| Provider Information | |||||||||
| NPI: | 1700394855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAGER | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2164 N LOWER BIRDIE GALYAN RD | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474089493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123201592 | ||||||||
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| Practice Location | |||||||||
| Address1: | 118 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460322923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175731037 | ||||||||
| FaxNumber: | 3172003965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2018 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 05004105A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 05004105A | 01 | IN | PT LICENSE | OTHER |