Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 5856 | TN |
NPI | 1003216326 |
---|---|
Provider Name | Jason Harp |
First Address | Bethpage, TN 37022-8381 |
Second Address | Springfield, TN 37172-4801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2014 |
Last Update Date | 25/08/2014 |