Provider Demographics
NPI:1083931000
Name:SHREVE, JASON C (DPT)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:SHREVE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 MYLAN PARK LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-2281
Mailing Address - Country:US
Mailing Address - Phone:304-997-0644
Mailing Address - Fax:304-983-7768
Practice Address - Street 1:460 MYLAN PARK LN
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2281
Practice Address - Country:US
Practice Address - Phone:304-997-0644
Practice Address - Fax:304-983-7768
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT002789225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic