Provider Demographics
NPI:1558521484
Name:CARUSO, JASON A (PTA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:A
Last Name:CARUSO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6226 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6325
Mailing Address - Country:US
Mailing Address - Phone:352-597-8996
Mailing Address - Fax:352-597-2809
Practice Address - Street 1:6226 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34613-6325
Practice Address - Country:US
Practice Address - Phone:352-597-8996
Practice Address - Fax:352-597-2809
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21061225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant