Provider Demographics
NPI:1538917380
Name:LAVARNWAY, JAROD RAYMOND (PTA)
Entity type:Individual
Prefix:
First Name:JAROD
Middle Name:RAYMOND
Last Name:LAVARNWAY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GREENLEAF ST
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2704
Mailing Address - Country:US
Mailing Address - Phone:603-682-8514
Mailing Address - Fax:
Practice Address - Street 1:25 GREENLEAF ST
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2704
Practice Address - Country:US
Practice Address - Phone:603-682-8514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8681225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant