MEDICARE: JASON RICHARD MATHEWS MS, ATC, PTA

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	225200000X	Physical Therapy Assistant	07828	OH
2	2255A2300X	Athletic Trainer	002820	OH

General Provider Information

NPI Number	:	1366415697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON RICHARD MATHEWS MS, ATC, PTA

Provider Business Mailing Address
First Line	:	6001 HILLTOP TRAIL DR
Second Line	:
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-8688
Country	:	US
Telephone Number	:	614-453-5557
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-3707
Country	:	US
Telephone Number	:	614-949-9166
Fax Number	:

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	10/22/2010

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