MEDICARE: JASON CLIFTON 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	2078393	TX

General Provider Information

NPI Number	:	1508627928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON CLIFTON PTA

Provider Business Mailing Address
First Line	:	3560 DIXIE DR APT 220
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77021-1260
Country	:	US
Telephone Number	:	713-444-3536
Fax Number	:

Provider Business Practice Location Address
First Line	:	6108 S RICE AVE # 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-2983
Country	:	US
Telephone Number	:	713-660-0663
Fax Number	:

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

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	01/22/2024

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