Provider Demographics
NPI:1801864194
Name:MCDONALD, JASON (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MCDONALD
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:PO BOX 573
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-0573
Mailing Address - Country:US
Mailing Address - Phone:330-224-6869
Mailing Address - Fax:
Practice Address - Street 1:3244 BAILEY ST NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3616
Practice Address - Country:US
Practice Address - Phone:330-418-8748
Practice Address - Fax:330-437-2440
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT010604225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2721460Medicaid
OH2721460Medicaid
OHMC4200342Medicare PIN