Provider Demographics
NPI:1952336984
Name:SCHWENGLER, JASON J (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:J
Last Name:SCHWENGLER
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:701-364-8906
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND833010700Medicaid
NDDA9011015523OtherPREFERRED ONE #
NDND200099OtherLHS #
ND50442Medicaid
MN77D48SCOtherMNBS #
NDHP25709OtherHEALTHPARTNERS #
ND14297OtherNDBS #
ND16Y72SCOtherMNBS #
MN77D47SCOtherMNBS #
ND6401674OtherMEDICA #
ND974514OtherAMERICA'S PPO/ARAZ #
ND6402311OtherMEDICA #
NDS93219Medicare UPIN
ND974514OtherAMERICA'S PPO/ARAZ #
ND6401674OtherMEDICA #
MN650017576Medicare ID - Type UnspecifiedRR MEDICARE #
ND50442Medicaid
ND833010700Medicaid