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NPI Code Detail

MEDICARE: JASON W PEDERSEN DPT

MEDICARE: JASON W PEDERSEN DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist087613IA
2225100000XPhysical TherapistPTL.0016232CO
3225100000XPhysical Therapist29714MD

General Provider Information

NPI Number : 1144744152
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON W PEDERSEN DPT
Provider Business Mailing Address
First Line : 33730 VIA SAN ANGELO DR
Second Line :
City : AVON
State : OH
Zip : 44011-3756
Country : US
Telephone Number : 440-934-6135
Fax Number : 440-934-6147
Provider Business Practice Location Address
First Line : 1836 GREENE TREE RD
Second Line :
City : PIKESVILLE
State : MD
Zip : 21208-1381
Country : US
Telephone Number : 410-486-9992
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2017
Last Update Date : 12/21/2024

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