Provider Demographics
NPI:1841521796
Name:HARGRAVE, JASON (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HARGRAVE
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13327 VILLA PARK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-3733
Mailing Address - Country:US
Mailing Address - Phone:917-756-7801
Mailing Address - Fax:
Practice Address - Street 1:7200 WYOMING SPGS STE 400
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4304
Practice Address - Country:US
Practice Address - Phone:512-255-6334
Practice Address - Fax:512-255-6962
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032242-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic