Provider Demographics
NPI:1902943426
Name:WILLIAMSON, JASON E (PT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:E
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3423
Mailing Address - Country:US
Mailing Address - Phone:304-697-1032
Mailing Address - Fax:304-526-1335
Practice Address - Street 1:2900 1ST AVE
Practice Address - Street 2:ST. MARY'S REHAB
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1241
Practice Address - Country:US
Practice Address - Phone:304-526-1333
Practice Address - Fax:304-526-1335
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT002363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist