Provider Demographics
NPI:1043242241
Name:REISS, JASON PATRICK (PT MPT OCS)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:PATRICK
Last Name:REISS
Suffix:
Gender:M
Credentials:PT MPT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2444 SANDELL DR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4548
Mailing Address - Country:US
Mailing Address - Phone:770-828-0208
Mailing Address - Fax:770-828-0208
Practice Address - Street 1:2669 OSBORNE RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319
Practice Address - Country:US
Practice Address - Phone:404-477-7777
Practice Address - Fax:404-477-7000
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P90322Medicare UPIN
GA65BBCDCMedicare ID - Type Unspecified