Provider Demographics
NPI:1376755645
Name:DOBYNS, JASSEN (ATC)
Entity Type:Individual
Prefix:MR
First Name:JASSEN
Middle Name:
Last Name:DOBYNS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 MIDDLE URBANA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-8212
Mailing Address - Country:US
Mailing Address - Phone:937-284-7357
Mailing Address - Fax:
Practice Address - Street 1:579 COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-2091
Practice Address - Country:US
Practice Address - Phone:937-484-1254
Practice Address - Fax:937-484-1223
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT. 0012832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer