Provider Demographics
NPI:1477782944
Name:DENTON, JASON MATTHEW (DPT, MS, CSCS)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:MATTHEW
Last Name:DENTON
Suffix:
Gender:M
Credentials:DPT, MS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CANOY LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-3153
Mailing Address - Country:US
Mailing Address - Phone:888-603-9235
Mailing Address - Fax:800-305-7112
Practice Address - Street 1:103 CANOY LN
Practice Address - Street 2:SUITE 103
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-3153
Practice Address - Country:US
Practice Address - Phone:888-603-9235
Practice Address - Fax:800-305-7112
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist