Healthcare Provider Details

I. General information

NPI: 1366406910
Provider Name (Legal Business Name): JASON STREIF WILWERT MPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 B W SPRUCE SEQUIM PHYSICAL THERAPY CTR PS
SEQUIM WA
98382
US

IV. Provider business mailing address

293 S RIDGEVIEW DR
PORT ANGELES WA
98362
US

V. Phone/Fax

Practice location:
  • Phone: 360-683-0632
  • Fax: 360-681-8453
Mailing address:
  • Phone: 360-457-1683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00007329
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0173768
Identifier TypeOTHER
Identifier State
Identifier IssuerWORKMAN'S COMP
# 2
IdentifierDA1273
Identifier TypeOTHER
Identifier State
Identifier IssuerMR
# 3
Identifier8355117
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 4
Identifier0170268
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerWORKMAN'S COMP
# 5
Identifier0170268
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerL & I
# 6
Identifier81061006701
Identifier TypeOTHER
Identifier State
Identifier IssuerKPS INSURANCE
# 7
Identifier8106WI
Identifier TypeOTHER
Identifier State
Identifier IssuerREGENCE INS
# 8
IdentifierP00017905
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 9
IdentifierDA1273
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE GRP
# 10
Identifier7117260
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: