Provider Demographics
NPI:1275658866
Name:SHEWCHUK, JASON ANDREW (MPT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ANDREW
Last Name:SHEWCHUK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CAMELOT CIR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-1015
Mailing Address - Country:US
Mailing Address - Phone:315-487-0938
Mailing Address - Fax:
Practice Address - Street 1:9 CAMELOT CIR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-1015
Practice Address - Country:US
Practice Address - Phone:315-487-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist