Provider Demographics
NPI:1497020721
Name:MOORE, JASON L (LMT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:L
Last Name:MOORE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:132 S MARKET ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-4765
Mailing Address - Country:US
Mailing Address - Phone:330-845-2273
Mailing Address - Fax:330-202-7791
Practice Address - Street 1:1920 SPRINGVILLE RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-9729
Practice Address - Country:US
Practice Address - Phone:330-845-2273
Practice Address - Fax:330-202-7791
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15846225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist