Provider Demographics
NPI:1952712275
Name:TJEERDSMA, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:TJEERDSMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3654 W ANTHEM WAY
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0455
Mailing Address - Country:US
Mailing Address - Phone:623-474-1950
Mailing Address - Fax:623-551-5480
Practice Address - Street 1:2100 S MARION RD STE 100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3647
Practice Address - Country:US
Practice Address - Phone:605-322-5156
Practice Address - Fax:605-322-5157
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10361225100000X
SD1970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist