Provider Demographics
NPI:1669880696
Name:BYRNE, JASON DAVID (ATC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DAVID
Last Name:BYRNE
Suffix:
Gender:M
Credentials:ATC
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 SOUTH ST
Mailing Address - Street 2:BRANDEIS UNIVERSITY SPORTS MEDICINE MS007
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-2728
Mailing Address - Country:US
Mailing Address - Phone:781-736-3664
Mailing Address - Fax:781-736-3656
Practice Address - Street 1:415 SOUTH ST
Practice Address - Street 2:BRANDEIS UNIVERSITY SPORTS MEDICINE MS007
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2728
Practice Address - Country:US
Practice Address - Phone:781-736-3664
Practice Address - Fax:781-736-3656
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA24532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer