Provider Demographics
NPI:1528008398
Name:SONCRANT, JASON P (PT, SCS, CSCS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:P
Last Name:SONCRANT
Suffix:
Gender:M
Credentials:PT, SCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 N REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2068
Mailing Address - Country:US
Mailing Address - Phone:419-578-7530
Mailing Address - Fax:419-539-0288
Practice Address - Street 1:2865 N REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2068
Practice Address - Country:US
Practice Address - Phone:419-578-7530
Practice Address - Fax:419-539-0288
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT07232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
290521271005OtherMMO
000000168697OtherANTHEM