Provider Demographics
NPI:1720016835
Name:EVERHARDT, JASON THEODORE (ATC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:THEODORE
Last Name:EVERHARDT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 HAZELWOOD DR.
Mailing Address - Street 2:APT L 130
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075
Mailing Address - Country:US
Mailing Address - Phone:615-944-7224
Mailing Address - Fax:
Practice Address - Street 1:121 HAZELWOOD DR
Practice Address - Street 2:APT. L130
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-5370
Practice Address - Country:US
Practice Address - Phone:615-944-7224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer