Provider Demographics
NPI:1366406910
Name:WILWERT, JASON STREIF (MPT, OCS)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:STREIF
Last Name:WILWERT
Suffix:
Gender:M
Credentials:MPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 S RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362
Mailing Address - Country:US
Mailing Address - Phone:360-457-1683
Mailing Address - Fax:
Practice Address - Street 1:124 B W SPRUCE
Practice Address - Street 2:SEQUIM PHYSICAL THERAPY CTR PS
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382
Practice Address - Country:US
Practice Address - Phone:360-683-0632
Practice Address - Fax:360-681-8453
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0173768OtherWORKMAN'S COMP
DA1273OtherMR
WA8355117Medicaid
WA0170268OtherWORKMAN'S COMP
WA0170268OtherL & I
81061006701OtherKPS INSURANCE
8106WIOtherREGENCE INS
P00017905OtherRAILROAD MEDICARE
DA1273OtherRAILROAD MEDICARE GRP
WA7117260Medicaid
DA1273OtherRAILROAD MEDICARE GRP
WA8355117Medicaid