Provider Demographics
NPI:1801183462
Name:REA, JASON (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:REA
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 1:2501 W WILLIAM CANNON DR BLDG 1, SUITE 102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5281
Mailing Address - Country:US
Mailing Address - Phone:512-651-0301
Mailing Address - Fax:512-651-0305
Practice Address - Street 1:2501 W WILLIAM CANNON DR BLDG 1, SUITE 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5281
Practice Address - Country:US
Practice Address - Phone:512-651-0301
Practice Address - Fax:512-651-0305
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1207937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB148772Medicare PIN
TXTXB148771Medicare PIN
TX00636YMedicare PIN
TX00X553Medicare PIN