Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 28026 | FL |
Y | 2251G0304X | Physical Therapist - Geriatrics | 9009 | TN |
NPI | 1205231487 |
---|---|
Provider Name | Jason Edward Therrien |
First Address | Hixson, TN 37343-2473 |
Second Address | Chattanooga, TN 37404-1730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2014 |
Last Update Date | 19/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q025007 | (05) | TN |