Provider Demographics
NPI:1619000171
Name:LUND, JASON RYAN (MSPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:RYAN
Last Name:LUND
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 1:1805 S BELLAIRE ST
Mailing Address - Street 2:SUITE 235
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4305
Mailing Address - Country:US
Mailing Address - Phone:303-756-3388
Mailing Address - Fax:
Practice Address - Street 1:1805 S BELLAIRE ST
Practice Address - Street 2:SUITE 235
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4305
Practice Address - Country:US
Practice Address - Phone:303-756-3388
Practice Address - Fax:303-756-3399
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO811181Medicare UPIN