Provider Demographics
NPI:1952637845
Name:STUTZ, JASON ISAAC (LMP)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ISAAC
Last Name:STUTZ
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W OLYMPIC PL
Mailing Address - Street 2:#506
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-4731
Mailing Address - Country:US
Mailing Address - Phone:206-234-8111
Mailing Address - Fax:
Practice Address - Street 1:101 W OLYMPIC PL
Practice Address - Street 2:#506
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4731
Practice Address - Country:US
Practice Address - Phone:206-234-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60058274172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist