Provider Demographics
NPI:1013374289
Name:SMITH, JASON (LPTA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 S LOGAN ST APT 101
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4148
Mailing Address - Country:US
Mailing Address - Phone:314-229-3595
Mailing Address - Fax:
Practice Address - Street 1:960 S LOGAN ST APT 101
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4148
Practice Address - Country:US
Practice Address - Phone:314-229-3595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00131102225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant