Provider Demographics
NPI:1851595755
Name:BARLOW, JASON MELVIN (PTA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:MELVIN
Last Name:BARLOW
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13425 SWCR 2340
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76681
Mailing Address - Country:US
Mailing Address - Phone:903-362-3444
Mailing Address - Fax:903-362-1867
Practice Address - Street 1:3301 W PARK ROW BLVD
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4846
Practice Address - Country:US
Practice Address - Phone:903-874-5238
Practice Address - Fax:903-874-5238
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2058759225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant