Provider Demographics
NPI:1093031965
Name:ROBLES, JASON (LMT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ROBLES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S RIVER DR UNIT 1012
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-4657
Mailing Address - Country:US
Mailing Address - Phone:480-326-5996
Mailing Address - Fax:
Practice Address - Street 1:1731 W BASELINE RD STE 111
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5782
Practice Address - Country:US
Practice Address - Phone:480-775-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-11989225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist