MEDICARE: MR. JASON A. KEMISH MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	7848	CT
2	2251G0304X	Geriatric Physical Therapist	7848	CT
3	2251N0400X	Neurology Physical Therapist	7848	CT
4	2251S0007X	Sports Physical Therapist	7848	CT
5	2251X0800X	Orthopedic Physical Therapist	7848	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36401	OTHER	CT	CIGNA HEALTHCARE
2	0036401	OTHER	CT	PRIVATE HEALTHCARE SYSTEMS
3	ANC1648	OTHER	CT	OXFORD HEALTHCARE
4	06-1090356	OTHER	CT	JASON A. KEMISH. MSPT
5	7848	OTHER	CT	JASON A. KEMISH, MSPT
6	015353	OTHER	CT	CONNECTICARE
7	2V8222	OTHER	CT	HEALTHNET
8	623570	OTHER	CT	TUFTS HEALTHCARE
9	080007848CT01	OTHER	CT	ANTHEM BLUE CROSS AND BLUE SHIED
10	119457	OTHER	CT	AETNA

General Provider Information

NPI Number	:	1407805179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON A. KEMISH MSPT

Provider Business Mailing Address
First Line	:	506 CROMWELL AVE
Second Line	:	SUITE 103
City	:	ROCKY HILL
State	:	CT
Zip	:	06067-1851
Country	:	US
Telephone Number	:	860-721-9801
Fax Number	:	860-721-8475

Provider Business Practice Location Address
First Line	:	506 CROMWELL AVE
Second Line	:	SUITE 103
City	:	ROCKY HILL
State	:	CT
Zip	:	06067-1851
Country	:	US
Telephone Number	:	860-721-9801
Fax Number	:	860-721-8475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	12/07/2010

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