Provider Demographics
NPI:1750320016
Name:MEYER, JASON EDWARD (PT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:EDWARD
Last Name:MEYER
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 1:4005 WESTMARK DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2271
Mailing Address - Country:US
Mailing Address - Phone:563-588-3891
Mailing Address - Fax:563-588-3893
Practice Address - Street 1:4005 WESTMARK DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2271
Practice Address - Country:US
Practice Address - Phone:563-588-3891
Practice Address - Fax:563-588-3893
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA37591OtherBLUE SHIELD PROV. NUMBER
IA0128702Medicaid
IA0128702Medicaid