Provider Demographics
NPI:1114907110
Name:WEBER, JASON A (RPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:WEBER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTOR
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-248-4141
Mailing Address - Fax:508-248-4106
Practice Address - Street 1:20 SOUTHBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507
Practice Address - Country:US
Practice Address - Phone:508-248-4141
Practice Address - Fax:508-248-4106
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13287225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherONE HEALTH PLAN
AA4052OtherHARVARD PILGRIM HEALTHCAR
0331660OtherMEDICAID/WELFARE
785967OtherMVP HEALTH CARE
2779432001OtherCIGNA PAL ID (REFERRAL #)
35481155OtherCIGNA HEALTHSOURCE
48327OtherFALLON COMMUNITY HEALTH P
Y67944OtherBLUE CARE ELECT
042472266OtherHEALTHCARE VALUE MANAGMEN
042472266OtherPRIVATE HEALTHCARE SYSTEM
2779432OtherCIGNA HEALTH PLAN
Y67944OtherBLUE SHIELD HMO BLUE
Y68672OtherMEDICARE B
MA0331660OtherMEDICAID/WELFARE
MA0331660Medicaid
650019549OtherRAILROAD MEDICARE
042472266OtherTHREE RIVERS
7292628OtherAETNA/US HEALTHCARE
Y67944OtherBLUE SHIELD INDEMNITY
35481155OtherCIGNA HEALTHSOURCE