Provider Demographics
NPI:1912340092
Name:SCHADLER, JASON TODD (LMP)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:TODD
Last Name:SCHADLER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 VINE ST APT 9
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1552
Mailing Address - Country:US
Mailing Address - Phone:509-430-1729
Mailing Address - Fax:
Practice Address - Street 1:1202 E PINE ST UNIT 103
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3929
Practice Address - Country:US
Practice Address - Phone:206-329-2026
Practice Address - Fax:206-629-2101
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60335609225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist