Jade Physical Therapy & Wellness Inc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

41255 Issued in CA

Legal business name

JADE PHYSICAL THERAPY & WELLNESS INC

Practice address

1575 N Lake Ave
Ste 205
Pasadena, CA 91104-2340

Phone

(626) 566-8332

Fax

(888) 624-7542

NPI assigned

Jun 20, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fernando Luis Soutullo, PT

Title

President

Phone

(626) 566-8332

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440115200000",
    "number": "1609258128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "819 WRIGHT AVE",
            "address_2": "APT 28",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911044474",
            "telephone_number": "786-306-0778",
            "fax_number": "888-624-7542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 N LAKE AVE",
            "address_2": "STE 205",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911042340",
            "telephone_number": "626-566-8332",
            "fax_number": "888-624-7542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JADE PHYSICAL THERAPY & WELLNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-20",
        "last_updated": "2015-08-21",
        "status": "A",
        "authorized_official_last_name": "SOUTULLO",
        "authorized_official_first_name": "FERNANDO",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-566-8332",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "41255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Rose Jacobs, MD
• Shanna Denise Jacobsen, CCAPP
• William Warner Jacobson II, D.C.
• Paul Dante Jacoy, D.C.
• Patrick Elie Jacques
• Nina Jaeger
• Lukas Jaeggi, PHD
• Anisha Jaggi
• Amanda Jagielski
• Jagvinder Singh Medical Corp

• Physical Therapy Clinic/Center in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Physical Therapy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.