Provider Demographics
NPI:1891946141
Name:PERRY, JASON ROBERT (MSPT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ROBERT
Last Name:PERRY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 REYNOLDS STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702-7530
Mailing Address - Country:US
Mailing Address - Phone:570-574-2568
Mailing Address - Fax:
Practice Address - Street 1:580 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17702-7530
Practice Address - Country:US
Practice Address - Phone:570-574-2568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist