Provider Demographics
NPI:1194438317
Name:TOVAR, JASON ELISEO (LMBT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ELISEO
Last Name:TOVAR
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 RAMSEY ST STE 150
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9314
Mailing Address - Country:US
Mailing Address - Phone:910-822-7722
Mailing Address - Fax:
Practice Address - Street 1:6200 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-9314
Practice Address - Country:US
Practice Address - Phone:910-822-7722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11853225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist