Healthcare Provider Details

I. General information

NPI: 1205231487
Provider Name (Legal Business Name): JASON EDWARD THERRIEN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N MARKET ST
CHATTANOOGA TN
37405-3904
US

IV. Provider business mailing address

4109 MOUNTAIN VIEW AVE STE 100
CHATTANOOGA TN
37415-2096
US

V. Phone/Fax

Practice location:
  • Phone: 423-842-9322
  • Fax: 866-591-0619
Mailing address:
  • Phone: 423-842-9322
  • Fax: 866-591-0619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9009
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP062737T
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: