Provider Demographics
NPI:1952389371
Name:WEST, JASON C (MPT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:C
Last Name:WEST
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3342
Mailing Address - Country:US
Mailing Address - Phone:307-857-7074
Mailing Address - Fax:307-856-6459
Practice Address - Street 1:820 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3342
Practice Address - Country:US
Practice Address - Phone:307-857-7074
Practice Address - Fax:307-856-6459
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT1956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT35853024000001OtherBLUE CROSS BLUE SHIELD
WYPT1956OtherSTATE ISSUED PHYSICAL THERAPY LICENSE
UT73901OtherPEHP