MEDICARE: JASON ROBERT GRIFFIN MT

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
1	172M00000X	Mechanotherapist

General Provider Information

NPI Number	:	1225301252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON ROBERT GRIFFIN MT

Provider Business Mailing Address
First Line	:	2270 N CECIL RD
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-4417
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2270 N CECIL RD
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-4417
Country	:	US
Telephone Number	:	360-808-3888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	02/22/2012

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