Provider Demographics
NPI:1871723916
Name:JAIN, ANUJ K (PT)
Entity type:Individual
Prefix:
First Name:ANUJ
Middle Name:K
Last Name:JAIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2618
Mailing Address - Country:US
Mailing Address - Phone:901-221-2619
Mailing Address - Fax:866-380-3102
Practice Address - Street 1:110 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2618
Practice Address - Country:US
Practice Address - Phone:901-221-2619
Practice Address - Fax:866-380-3102
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist