Provider Demographics
NPI:1629317698
Name:ABBUHL, JASON LEE (DPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LEE
Last Name:ABBUHL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1407 KODIAK CT
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1379
Mailing Address - Country:US
Mailing Address - Phone:712-310-1749
Mailing Address - Fax:319-665-2631
Practice Address - Street 1:3290 RIDGEWAY DR STE 3
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2023
Practice Address - Country:US
Practice Address - Phone:319-665-2630
Practice Address - Fax:319-665-2630
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA005113208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation