Provider Demographics
NPI:1669873428
Name:FREI, JASON T (DPT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:FREI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 HAUGEN ST
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9403
Mailing Address - Country:US
Mailing Address - Phone:970-310-4524
Mailing Address - Fax:
Practice Address - Street 1:2129 HAUGEN ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9403
Practice Address - Country:US
Practice Address - Phone:970-310-4524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2021-05-12
Deactivation Date:2021-03-11
Deactivation Code:
Reactivation Date:2021-05-10
Provider Licenses
StateLicense IDTaxonomies
WYPT-1971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48807826Medicaid
COP01502641OtherRR MEDICARE
CO48807826Medicaid