Provider Demographics
NPI:1548389034
Name:PRIVETT, JASON L (PT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:L
Last Name:PRIVETT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11729 SPRINGFIELD PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2311
Mailing Address - Country:US
Mailing Address - Phone:513-671-5841
Mailing Address - Fax:513-671-5106
Practice Address - Street 1:7450 S MASON MONTGOMERY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7891
Practice Address - Country:US
Practice Address - Phone:513-336-0540
Practice Address - Fax:513-336-6064
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT008368225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPR4096746Medicare PIN