Provider Demographics
NPI:1689855785
Name:HUGENTOBLER, JASON ADAM (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ADAM
Last Name:HUGENTOBLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 MADISON RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-2276
Mailing Address - Country:US
Mailing Address - Phone:513-871-5571
Mailing Address - Fax:513-871-6761
Practice Address - Street 1:2727 MADISON RD
Practice Address - Street 2:SUITE 301
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-2276
Practice Address - Country:US
Practice Address - Phone:513-871-5571
Practice Address - Fax:513-871-6761
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist