Provider Demographics
NPI:1023257383
Name:BUONO, JASON ALLEN (PT, DPT, ATC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ALLEN
Last Name:BUONO
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-1870
Mailing Address - Country:US
Mailing Address - Phone:360-736-5273
Mailing Address - Fax:360-736-5053
Practice Address - Street 1:1118 VIEW AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-1870
Practice Address - Country:US
Practice Address - Phone:360-736-5273
Practice Address - Fax:360-736-5053
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8950386OtherCRIME VICTIMS
WA8534935OtherDSHS
WAG8879286Medicare PIN
WAP00880874OtherRAILROAD MEDICARE
WA0246189OtherL&I