Provider Demographics
NPI:1346243037
Name:WARD, JASON DOUGLAS (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DOUGLAS
Last Name:WARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 WOLF RIVER BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1708
Mailing Address - Country:US
Mailing Address - Phone:901-522-6671
Mailing Address - Fax:901-522-6715
Practice Address - Street 1:7730 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1708
Practice Address - Country:US
Practice Address - Phone:901-522-6671
Practice Address - Fax:901-522-6715
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT6807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0723280001OtherPALMETTO
TN4063289OtherBCBS
TNP00314160OtherRAILROAD MEDICARE
TN3645189Medicaid
TN4063289OtherBCBS