Provider Demographics
NPI:1457600546
Name:GUMPRECHT, JASON S (PT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:S
Last Name:GUMPRECHT
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 1:601 GATES ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2288
Mailing Address - Country:US
Mailing Address - Phone:607-584-7389
Mailing Address - Fax:607-772-1223
Practice Address - Street 1:401 MAIN STREET
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2018
Practice Address - Country:US
Practice Address - Phone:607-798-8800
Practice Address - Fax:607-798-8801
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist