Provider Demographics
NPI:1992731764
Name:R JASON KENT PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:R JASON KENT PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:478-333-3075
Mailing Address - Street 1:150 OSIGIAN BLVD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088
Mailing Address - Country:US
Mailing Address - Phone:478-333-3075
Mailing Address - Fax:478-333-3484
Practice Address - Street 1:150 OSIGIAN BLVD.
Practice Address - Street 2:SUITE 300
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-333-3075
Practice Address - Fax:478-333-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-10-01
Deactivation Date:2018-09-06
Deactivation Code:
Reactivation Date:2018-09-13
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225100000X
GAPT007275261QP2000X
GAPT012102261QP2000X
GAPT012135261QP2000X
GAPT013016261QP2000X
GAPT012607261QP2000X
GAPT013258261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========Medicaid