Provider Demographics
NPI:1407821556
Name:WHIGHAM, JASON SCOTT (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:SCOTT
Last Name:WHIGHAM
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 1:63 WINTHROP LN
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2540
Mailing Address - Country:US
Mailing Address - Phone:508-864-6205
Mailing Address - Fax:
Practice Address - Street 1:319A SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2598
Practice Address - Country:US
Practice Address - Phone:508-832-2628
Practice Address - Fax:508-832-4099
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7574763OtherAETA PIN
MA3322108OtherAETNA
MA0322351Medicaid
MA9306424OtherPHCS
MAY68255OtherBCBS
MAY68255OtherBCBS