MEDICARE: JASON SALISBURY PT, 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	PT011605	GA

General Provider Information

NPI Number	:	1649670746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON SALISBURY PT, DPT

Provider Business Mailing Address
First Line	:	8492 HIRAM ACWORTH HWY STE 211
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-4710
Country	:	US
Telephone Number	:	678-687-0630
Fax Number	:	678-647-7985

Provider Business Practice Location Address
First Line	:	8492 HIRAM ACWORTH HWY STE 211
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-4710
Country	:	US
Telephone Number	:	678-687-0630
Fax Number	:	678-647-7985

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

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	09/20/2023

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