Provider Demographics
NPI:1972512549
Name:MUCHOW, JASON AUGUST (AT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:AUGUST
Last Name:MUCHOW
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-5209
Mailing Address - Country:US
Mailing Address - Phone:816-289-2845
Mailing Address - Fax:
Practice Address - Street 1:ATHLETIC TRAINING SERVICES MISSOURI STATE UNIVERSITY
Practice Address - Street 2:901 S NATIONAL AVE
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65897-0001
Practice Address - Country:US
Practice Address - Phone:417-836-5461
Practice Address - Fax:417-836-6101
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060179042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer