Provider Demographics
NPI:1003397209
Name:DIPIERRO, JASON LEE (PTA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LEE
Last Name:DIPIERRO
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 1:28 TERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-4819
Mailing Address - Country:US
Mailing Address - Phone:518-379-8256
Mailing Address - Fax:
Practice Address - Street 1:28 TERRY AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-4819
Practice Address - Country:US
Practice Address - Phone:518-379-8256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant