Provider Demographics
NPI:1255773982
Name:SUMMERS, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 TABLE MESA DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5869
Mailing Address - Country:US
Mailing Address - Phone:303-499-9892
Mailing Address - Fax:
Practice Address - Street 1:3400 TABLE MESA DR
Practice Address - Street 2:SUITE 203
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5869
Practice Address - Country:US
Practice Address - Phone:303-499-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11363225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist