Provider Demographics
NPI:1477907251
Name:MOUYEOS, JASON (ATC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:MOUYEOS
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:UNIVERSITY AT BUFFALO
Mailing Address - Street 2:STADIUM COMPLEX RM 130
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14260-0001
Mailing Address - Country:US
Mailing Address - Phone:716-645-6829
Mailing Address - Fax:716-645-5574
Practice Address - Street 1:UNIVERSITY AT BUFFALO
Practice Address - Street 2:STADIUM COMPLEX RM 130
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14260-0001
Practice Address - Country:US
Practice Address - Phone:716-645-6829
Practice Address - Fax:716-645-5574
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0012392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer