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General NPI Number Information
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NPI Number | 1023786019
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Entity Type | Individual
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Provider Name | JASON TAN DPT
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Gender | Male
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 204 WORCESTER ST
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City | WELLESLEY
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State | MA
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Zip | 02481-5473
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Country | US
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Telephone | 781-772-2406
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Fax | 844-912-8608
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Provider Business Mailing Address
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Address Line | 4 RICHMOND SQ
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City | PROVIDENCE
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State | RI
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Zip | 02906-5117
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Country | US
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Telephone | 401-433-4172
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Fax | 401-433-0612
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 25756
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License Number State | MA
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