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: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 N LYERLY ST STE 200
CHATTANOOGA TN
37404-2728
US

IV. Provider business mailing address

4702 PRESERVE DR
CHATTANOOGA TN
37416-6113
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-0850
  • Fax: 423-698-0511
Mailing address:
  • Phone: 706-284-9816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number28026
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number9009
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: