Provider Demographics
NPI:1679794283
Name:SCARBROUGH, JASON (PTA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SCARBROUGH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13707 FM 901
Mailing Address - Street 2:
Mailing Address - City:SADLER
Mailing Address - State:TX
Mailing Address - Zip Code:76264
Mailing Address - Country:US
Mailing Address - Phone:903-814-9054
Mailing Address - Fax:
Practice Address - Street 1:2120 HWY 1417 N
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092
Practice Address - Country:US
Practice Address - Phone:903-892-4800
Practice Address - Fax:903-892-4444
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2035202225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant