Provider Demographics
NPI:1487016044
Name:BIRD, JASON PETER (DPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:PETER
Last Name:BIRD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8840 CYPRESS WATERS BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4594
Mailing Address - Country:US
Mailing Address - Phone:615-977-9433
Mailing Address - Fax:
Practice Address - Street 1:8840 CYPRESS WATERS BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4594
Practice Address - Country:US
Practice Address - Phone:615-977-9433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41782225100000X
TN9945225100000X
TX1269463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist