Provider Demographics
NPI:1689844029
Name:HEIMARK, JASON (MSPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HEIMARK
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 1:576 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4002
Mailing Address - Country:US
Mailing Address - Phone:303-534-1225
Mailing Address - Fax:303-534-1227
Practice Address - Street 1:576 S BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4002
Practice Address - Country:US
Practice Address - Phone:303-534-1225
Practice Address - Fax:303-534-1227
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841601741OtherTIN