Provider Demographics
NPI:1417165861
Name:KAMPF, JASON (PT, MTC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:KAMPF
Suffix:
Gender:M
Credentials:PT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:SILESIA
Mailing Address - State:MT
Mailing Address - Zip Code:59041-9731
Mailing Address - Country:US
Mailing Address - Phone:360-621-3627
Mailing Address - Fax:
Practice Address - Street 1:45 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:SILESIA
Practice Address - State:MT
Practice Address - Zip Code:59041-9731
Practice Address - Country:US
Practice Address - Phone:360-621-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32798225100000X
AK1748225100000X
WAPT00009109225100000X
OR5363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist