Provider Demographics
NPI:1770637597
Name:ROE, JASON JOHN (LAT, ATC, CMT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:JOHN
Last Name:ROE
Suffix:
Gender:M
Credentials:LAT, ATC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 GLENARDEN DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3603
Mailing Address - Country:US
Mailing Address - Phone:702-496-0545
Mailing Address - Fax:
Practice Address - Street 1:5025 GLENARDEN DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3603
Practice Address - Country:US
Practice Address - Phone:702-496-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05060962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer