Provider Demographics
NPI:1992768279
Name:MEREDITH, JASON THOMAS (ATC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:THOMAS
Last Name:MEREDITH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 PALENCIA DR
Mailing Address - Street 2:APT 2008
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1827
Mailing Address - Country:US
Mailing Address - Phone:352-283-0489
Mailing Address - Fax:
Practice Address - Street 1:8302 MONTAGUE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-6014
Practice Address - Country:US
Practice Address - Phone:352-283-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL19462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer