Provider Demographics
NPI:1306033568
Name:JASON J. PUTZ PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:JASON J. PUTZ PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:J
Authorized Official - Last Name:PUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:563-875-8615
Mailing Address - Street 1:613 1/2 16TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DYERSVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52040-2050
Mailing Address - Country:US
Mailing Address - Phone:563-875-8615
Mailing Address - Fax:563-875-8722
Practice Address - Street 1:613 1/2 16TH AVE SE
Practice Address - Street 2:
Practice Address - City:DYERSVILLE
Practice Address - State:IA
Practice Address - Zip Code:52040-2050
Practice Address - Country:US
Practice Address - Phone:563-875-8615
Practice Address - Fax:563-875-8722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03051261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy