Provider Demographics
NPI:1003201286
Name:RAMBO, JASON (CAR)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:RAMBO
Suffix:
Gender:M
Credentials:CAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NW E ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2010
Mailing Address - Country:US
Mailing Address - Phone:541-778-2977
Mailing Address - Fax:
Practice Address - Street 1:120 NW E ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2010
Practice Address - Country:US
Practice Address - Phone:541-778-2977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20583225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist