Provider Demographics
NPI:1083615702
Name:YUNKER, JASON P (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:P
Last Name:YUNKER
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 1:3221 FREDERICA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6086
Mailing Address - Country:US
Mailing Address - Phone:270-926-2212
Mailing Address - Fax:270-926-2215
Practice Address - Street 1:3221 FREDERICA ST
Practice Address - Street 2:SUITE B
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6086
Practice Address - Country:US
Practice Address - Phone:270-926-2212
Practice Address - Fax:270-926-2215
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000190431OtherANTHEM
KY87001756Medicaid
KYP00204194OtherRR MEDICARE
KYK005560OtherTRICARE
KY87001756Medicaid