Provider Demographics
NPI:1811040082
Name:OVERHOLSER, JASON C (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:C
Last Name:OVERHOLSER
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 1:15085 GOLDENROD DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-7001
Mailing Address - Country:US
Mailing Address - Phone:775-240-1059
Mailing Address - Fax:
Practice Address - Street 1:604 WEST WASHINGTION STREET
Practice Address - Street 2:SUITE B
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701
Practice Address - Country:US
Practice Address - Phone:775-240-1059
Practice Address - Fax:775-849-7968
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508412Medicaid