Provider Demographics
NPI:1023328804
Name:DORSCH, JASON CHRISTOPHER (PT, ATC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:DORSCH
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 S RIORDAN RANCH ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-6372
Mailing Address - Country:US
Mailing Address - Phone:928-214-7303
Mailing Address - Fax:928-214-0696
Practice Address - Street 1:1510 S RIORDAN RANCH ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-6372
Practice Address - Country:US
Practice Address - Phone:928-214-7303
Practice Address - Fax:928-214-0696
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ875843Medicaid
AZ9032OtherARIZONA PHYSICAL THERAPY LICENSE
AZ0846OtherARIZONA ATHLETIC TRAINING STATE LICENSE