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General NPI Number Information
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NPI Number | 1144744152
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Entity Type | Individual
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Provider Name | JASON W PEDERSEN DPT
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Gender | Male
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 1836 GREENE TREE RD
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City | PIKESVILLE
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State | MD
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Zip | 21208-1381
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Country | US
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Telephone | 410-486-9992
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Fax |
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Provider Business Mailing Address
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Address Line | 33730 VIA SAN ANGELO DR
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City | AVON
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State | OH
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Zip | 44011-3756
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Country | US
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Telephone | 440-934-6135
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Fax | 440-934-6147
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 087613
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL.0016232
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 29714
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License Number State | MD
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