Basic Information
| Provider Information | |||||||||
| NPI: | 1780041269 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ANCER | ||||||||
| FirstName: | JAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 FIANNA WAY | ||||||||
| Address2: | MAIL DROP 2761 | ||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729192761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778238375 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2110 FLEISCHMANN RD | ||||||||
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| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323080562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2294603765 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2016 | ||||||||
| LastUpdateDate: | 01/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.