Provider Demographics
NPI:1619933017
Name:HYDER, JASON E (MPT,OCS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:E
Last Name:HYDER
Suffix:
Gender:M
Credentials:MPT,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 S PATRICK DR
Mailing Address - Street 2:STE 3
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4400
Mailing Address - Country:US
Mailing Address - Phone:321-773-8155
Mailing Address - Fax:321-773-8154
Practice Address - Street 1:2030 S PATRICK DR
Practice Address - Street 2:STE 3
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4400
Practice Address - Country:US
Practice Address - Phone:321-773-8155
Practice Address - Fax:321-773-8154
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA011267002251S0007X, 2251X0800X
FLPT227042251X0800X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK-3234OtherBEACHSIDE P.T. MEDICARE GROUP NUMBER
FLPT-22704OtherSTATE OF FL. P.T. LICENSE NUMBER
FLEW866ZMedicare PIN