Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT002789 | WV |
N | 2251S0007X | Physical Therapist - Sports | PT002789 | WV |
N | 2251X0800X | Physical Therapist - Orthopedic | PT002789 | WV |
NPI | 1083931000 |
---|---|
Provider Name | Dr. Jason C Shreve |
First Address | Morgantown, WV 26501-2281 |
Second Address | Morgantown, WV 26501-2281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2010 |
Last Update Date | 18/08/2010 |