Provider Demographics
NPI:1477513281
Name:KIZZEE, JASON RAY (ATC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:RAY
Last Name:KIZZEE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
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Mailing Address - Street 1:119 WOODMIST WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4215
Mailing Address - Country:US
Mailing Address - Phone:401-935-4023
Mailing Address - Fax:401-841-2127
Practice Address - Street 1:440 MEYERKORD AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02841-1650
Practice Address - Country:US
Practice Address - Phone:401-935-4023
Practice Address - Fax:401-841-2127
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIAT001692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer