MEDICARE: MR. JASON T MERRITT PT

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	225100000X	Physical Therapist	CP014700T	AR
2	225100000X	Physical Therapist	03718	LA

General Provider Information

NPI Number	:	1255069712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON T MERRITT PT

Provider Business Mailing Address
First Line	:	103 MOUNTAIN PLACE DR STE B
Second Line	:
City	:	MOUNTAIN VIEW
State	:	AR
Zip	:	72560-6802
Country	:	US
Telephone Number	:	870-269-5215
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 MOUNTAIN PLACE DR STE B
Second Line	:
City	:	MOUNTAIN VIEW
State	:	AR
Zip	:	72560-6802
Country	:	US
Telephone Number	:	870-269-5215
Fax Number	:

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

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	08/11/2022

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Directions to “ MR. JASON T MERRITT PT” Practice Location

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