Provider Demographics
NPI:1881852358
Name:KAMM, JASON C (MPT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:C
Last Name:KAMM
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 APPALOOSA DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-8402
Mailing Address - Country:US
Mailing Address - Phone:307-635-3572
Mailing Address - Fax:
Practice Address - Street 1:2015 APPALOOSA DR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-8402
Practice Address - Country:US
Practice Address - Phone:307-635-3572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY#PT-1175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist