MEDICARE: MR. JASON D ALLRED 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
1	225100000X	Physical Therapist	PT1994	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417998162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON D ALLRED DPT

Provider Business Mailing Address
First Line	:	1588 W CAYUSE CREEK DR
Second Line	:	STE 200
City	:	MERIDIAN
State	:	ID
Zip	:	83646-4795
Country	:	US
Telephone Number	:	208-515-7575
Fax Number	:	208-515-7578

Provider Business Practice Location Address
First Line	:	1588 W CAYUSE CREEK DR
Second Line	:	STE 110
City	:	MERIDIAN
State	:	ID
Zip	:	83646-4795
Country	:	US
Telephone Number	:	208-515-7575
Fax Number	:	208-515-7578

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	06/11/2019

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Directions to “ MR. JASON D ALLRED DPT” Practice Location

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