Provider Demographics
NPI:1699037010
Name:PRATHER, JASON ALLAN (LMP)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ALLAN
Last Name:PRATHER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SW CAMPUS DR
Mailing Address - Street 2:APT. 17-103
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-6533
Mailing Address - Country:US
Mailing Address - Phone:253-880-8275
Mailing Address - Fax:
Practice Address - Street 1:1900 SW CAMPUS DR
Practice Address - Street 2:APT. 17-103
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-6533
Practice Address - Country:US
Practice Address - Phone:253-880-8275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60275802225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist