Provider Demographics
NPI:1487719639
Name:WAZ, JASON D (PT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:D
Last Name:WAZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:640 BROOKER CREEK BLVD
Mailing Address - Street 2:SUITE 425
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2929
Mailing Address - Country:US
Mailing Address - Phone:813-849-0150
Mailing Address - Fax:813-849-0151
Practice Address - Street 1:640 BROOKER CREEK BLVD
Practice Address - Street 2:SUITE 425
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-2929
Practice Address - Country:US
Practice Address - Phone:813-849-0150
Practice Address - Fax:813-849-0151
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2008-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPT14087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist