Provider Demographics
NPI:1629268271
Name:FOX, JASON GREGORY (MS, ATC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:GREGORY
Last Name:FOX
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 E CACHE LA POUDRE ST
Mailing Address - Street 2:ATHLETIC DEPARTMENT
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3243
Mailing Address - Country:US
Mailing Address - Phone:719-389-6208
Mailing Address - Fax:719-389-6993
Practice Address - Street 1:14 E CACHE LA POUDRE ST
Practice Address - Street 2:ATHLETIC DEPARTMENT
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3243
Practice Address - Country:US
Practice Address - Phone:719-389-6208
Practice Address - Fax:719-389-6993
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer