Provider Demographics
NPI:1992806137
Name:RYBOLT, JASON (PT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:RYBOLT
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 1:2217 S COUNTY ROAD 1084
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-5312
Mailing Address - Country:US
Mailing Address - Phone:432-556-1485
Mailing Address - Fax:
Practice Address - Street 1:2208 N LOOP 250 W
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-6011
Practice Address - Country:US
Practice Address - Phone:432-556-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1166503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist