Provider Demographics
NPI:1619234234
Name:BAITS, JASON ROBERT
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ROBERT
Last Name:BAITS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 HARTSEL DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4165
Mailing Address - Country:US
Mailing Address - Phone:719-535-2757
Mailing Address - Fax:719-535-2767
Practice Address - Street 1:3522 HARTSEL DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4165
Practice Address - Country:US
Practice Address - Phone:719-535-2757
Practice Address - Fax:719-535-2767
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12101225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant