Provider Demographics
NPI:1194784926
Name:EVERSMEYER, AARON JASON (PT)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:JASON
Last Name:EVERSMEYER
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 1:2023 CEDAR PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2283
Mailing Address - Country:US
Mailing Address - Phone:563-264-8638
Mailing Address - Fax:563-264-8639
Practice Address - Street 1:2023 CEDAR PLAZA DR
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2283
Practice Address - Country:US
Practice Address - Phone:563-264-8638
Practice Address - Fax:563-264-8639
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA36934OtherWELLMARK
IA0445494Medicaid
IA0445494Medicaid