Basic Information
| Provider Information | |||||||||
| NPI: | 1740548908 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TOWNSEND | ||||||||
| FirstName: | JAIAH | ||||||||
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| Credential: | RRT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4915 E GEMSTONE DR | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863015992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282025294 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 HWY 89N | ||||||||
| Address2: | NORTHERN ARIZONA VA HOSPITAL | ||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284454860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2012 | ||||||||
| LastUpdateDate: | 04/25/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227900000X | 73815 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | 227900000X | 009965 | AZ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered |
No ID Information.