Provider Demographics
NPI:1912252081
Name:BRANSON, JASON RYAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RYAN
Last Name:BRANSON
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 1:1845 S DOBSON RD STE 111
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5662
Mailing Address - Country:US
Mailing Address - Phone:480-572-1493
Mailing Address - Fax:480-550-7448
Practice Address - Street 1:1845 S DOBSON RD STE 111
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5662
Practice Address - Country:US
Practice Address - Phone:480-572-1493
Practice Address - Fax:480-550-7448
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ90920Medicare UPIN