Provider Demographics
NPI:1114302023
Name:BURTCHELL, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BURTCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SUNDERLAND DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-9233
Mailing Address - Country:US
Mailing Address - Phone:207-707-1409
Mailing Address - Fax:
Practice Address - Street 1:32 SUNDERLAND DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-9233
Practice Address - Country:US
Practice Address - Phone:207-707-1409
Practice Address - Fax:833-544-0823
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist