Provider Demographics
NPI:1114083854
Name:RADEMACHER, JASON ROBERT (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ROBERT
Last Name:RADEMACHER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ROZLYN CT
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-9616
Mailing Address - Country:US
Mailing Address - Phone:908-902-4540
Mailing Address - Fax:
Practice Address - Street 1:112 BROAD STREET
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-747-1211
Practice Address - Fax:732-747-6744
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10432255A2300X
NJ25MT001455002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer