Provider Demographics
NPI:1700363686
Name:KAWAMURA, JASON Y (DPT)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:Y
Last Name:KAWAMURA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4754 MARTIN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-3507
Mailing Address - Country:US
Mailing Address - Phone:770-967-4377
Mailing Address - Fax:770-967-8077
Practice Address - Street 1:2300 LIAM AVE STE 103
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2265
Practice Address - Country:US
Practice Address - Phone:470-294-0052
Practice Address - Fax:470-294-0053
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0134682251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic