Provider Demographics
NPI:1699914382
Name:KAVOUNTZIS, JASON STEPHEN (PT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:STEPHEN
Last Name:KAVOUNTZIS
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 1:87 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1262
Mailing Address - Country:US
Mailing Address - Phone:201-488-7905
Mailing Address - Fax:201-488-7901
Practice Address - Street 1:87 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1262
Practice Address - Country:US
Practice Address - Phone:201-488-7905
Practice Address - Fax:201-488-7901
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00917200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ064275Medicare UPIN