Provider Demographics
NPI:1316014673
Name:THOMAS, JASON (MPT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:THOMAS
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 1:600 NEW MARKET DR
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-2268
Mailing Address - Country:US
Mailing Address - Phone:215-721-4483
Mailing Address - Fax:215-721-4483
Practice Address - Street 1:600 NEW MARKET DR
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-2268
Practice Address - Country:US
Practice Address - Phone:215-721-4483
Practice Address - Fax:215-721-4483
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT014010L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01924006Medicaid
PA30011625OtherKEYSTONE MERCY ID#
PA0019240060002Medicaid
PA2025609000OtherPERSONAL CHOICE ID#
PA2025609000OtherBLUE CROSS ID#