Provider Demographics
NPI:1235150236
Name:MERZ, JASON K (PT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:K
Last Name:MERZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:519 S DEWEY
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103-0747
Mailing Address - Country:US
Mailing Address - Phone:308-534-0999
Mailing Address - Fax:308-534-7299
Practice Address - Street 1:120 WEST LEOTA STEET
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6036
Practice Address - Country:US
Practice Address - Phone:308-534-0999
Practice Address - Fax:308-534-7299
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084123332Medicaid
650020995OtherPALMETTO GBA RR MEDICARE
NE39861OtherBLUE CROSS BLUE SHIELD
P36309Medicare UPIN
NE39861OtherBLUE CROSS BLUE SHIELD