Provider Demographics
NPI:1225486608
Name:GUBLER, JASON CLARK (DPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:CLARK
Last Name:GUBLER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:801-475-3494
Practice Address - Street 1:698 12TH ST
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-6200
Practice Address - Country:US
Practice Address - Phone:801-475-3700
Practice Address - Fax:801-475-3701
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-4423225100000X
UT8704023-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1225486608Medicaid
IDPT-4423OtherSTATE LICENSE