Provider Demographics
NPI:1316526676
Name:WHISTLER, JASON MATTHEW (LMT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:MATTHEW
Last Name:WHISTLER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MICHAEL LN
Mailing Address - Street 2:
Mailing Address - City:WATSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17777-8070
Mailing Address - Country:US
Mailing Address - Phone:570-246-9991
Mailing Address - Fax:
Practice Address - Street 1:2346 N SUSQUEHANNA TRL
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-7776
Practice Address - Country:US
Practice Address - Phone:570-437-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG014030225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist