=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902943426
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON E WILLIAMSON P.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 1ST AVE ST. MARY'S REHAB
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25702-1241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-526-1333
-----------------------------------------------------
Fax | 304-526-1335
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1141 12TH AVE
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25701-3423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-697-1032
-----------------------------------------------------
Fax | 304-526-1335
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT002363
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------