Healthcare Provider Details

I. General information

NPI: 1568217016
Provider Name (Legal Business Name): JASON N UTZ DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 S MAIN ST
WAKE FOREST NC
27587-5011
US

IV. Provider business mailing address

2115 S MAIN ST
WAKE FOREST NC
27587-5011
US

V. Phone/Fax

Practice location:
  • Phone: 919-570-5755
  • Fax: 919-570-5756
Mailing address:
  • Phone: 919-570-5755
  • Fax: 919-570-5756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT021063
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP25096
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: