Provider Demographics
NPI:1073684700
Name:DOUGLAS, JASON PAUL (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:PAUL
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NEW ORLEANS BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-3346
Mailing Address - Country:US
Mailing Address - Phone:985-868-4487
Mailing Address - Fax:985-872-6869
Practice Address - Street 1:210 NEW ORLEANS BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-3346
Practice Address - Country:US
Practice Address - Phone:985-868-4487
Practice Address - Fax:985-872-6869
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist