Provider Demographics
NPI:1780918649
Name:LEBEAU, JASON JOHN (PT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:JOHN
Last Name:LEBEAU
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 1:300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERGENNES
Mailing Address - State:VT
Mailing Address - Zip Code:05491-1035
Mailing Address - Country:US
Mailing Address - Phone:802-877-6991
Mailing Address - Fax:802-877-6993
Practice Address - Street 1:812 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1555
Practice Address - Country:US
Practice Address - Phone:802-388-3991
Practice Address - Fax:802-388-3992
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist