MEDICARE: JASON ALEXANDER CHERRY MSPT,COMT

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	6695	CO

General Provider Information

NPI Number	:	1356403653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON ALEXANDER CHERRY MSPT,COMT

Provider Business Mailing Address
First Line	:	325 S TELLER ST STE 270
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-7389
Country	:	US
Telephone Number	:	303-274-2404
Fax Number	:	303-274-2406

Provider Business Practice Location Address
First Line	:	325 S TELLER ST STE 270
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-7389
Country	:	US
Telephone Number	:	303-274-2404
Fax Number	:	303-274-2406

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	03/25/2008

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