Provider Demographics
NPI:1972562999
Name:RACKMIL, JASON (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:RACKMIL
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 1:1060 NIAGARA FALLS BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-9300
Mailing Address - Country:US
Mailing Address - Phone:716-836-2225
Mailing Address - Fax:716-836-2712
Practice Address - Street 1:1060 NIAGARA FALLS BLVD STE 5
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9300
Practice Address - Country:US
Practice Address - Phone:716-836-2225
Practice Address - Fax:716-836-2712
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02654412251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA4871Medicare PIN