Provider Demographics
NPI:1497216097
Name:RUBENSTEIN, JASON MARC (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MARC
Last Name:RUBENSTEIN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 OCEAN ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2854
Mailing Address - Country:US
Mailing Address - Phone:201-522-9793
Mailing Address - Fax:
Practice Address - Street 1:193 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3392
Practice Address - Country:US
Practice Address - Phone:603-357-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT52892251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics