Provider Demographics
NPI:1083129266
Name:MEYER, JASON MATTHEW (MS, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:MATTHEW
Last Name:MEYER
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3847 6TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20714-3036
Mailing Address - Country:US
Mailing Address - Phone:401-954-4486
Mailing Address - Fax:
Practice Address - Street 1:3847 6TH ST
Practice Address - Street 2:
Practice Address - City:NORTH BEACH
Practice Address - State:MD
Practice Address - Zip Code:20714-3036
Practice Address - Country:US
Practice Address - Phone:401-954-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-09
Last Update Date:2017-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAT-2932255A2300X
PART0061492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer