Provider Demographics
NPI:1194044479
Name:MYERS, JASON A (MSPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:MYERS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5183 LYLE DR
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-9721
Mailing Address - Country:US
Mailing Address - Phone:315-382-8939
Mailing Address - Fax:888-817-4702
Practice Address - Street 1:5183 LYLE DR
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:NY
Practice Address - Zip Code:13041-9721
Practice Address - Country:US
Practice Address - Phone:315-382-8939
Practice Address - Fax:888-817-4702
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021324-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist