Provider Demographics
NPI:1598978975
Name:TRENOUTH, JASON WALTER (MSPT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:WALTER
Last Name:TRENOUTH
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CENTRE ST # A
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1238
Mailing Address - Country:US
Mailing Address - Phone:617-699-2851
Mailing Address - Fax:
Practice Address - Street 1:151 CENTRE ST # A
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1238
Practice Address - Country:US
Practice Address - Phone:617-699-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist