Provider Demographics
NPI:1922275726
Name:WEST, CHARLES JASON (DPT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JASON
Last Name:WEST
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-0729
Mailing Address - Country:US
Mailing Address - Phone:334-793-2663
Mailing Address - Fax:334-836-2247
Practice Address - Street 1:1008 BOLL WEEVIL CIR STE C
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-3400
Practice Address - Country:US
Practice Address - Phone:334-352-3331
Practice Address - Fax:334-268-5045
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH5351225100000X
FLPT23134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-09123OtherBCBS OF ALABAMA
AL103110Medicaid
AL121677Medicaid
AL515-92313OtherBCBS - EPRISE
AL511-09123OtherBCBS OF ALABAMA