Basic Information
| Provider Information | |||||||||
| NPI: | 1467117473 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RANCOURT | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | DONALD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 BUNTING RD | ||||||||
| Address2: | |||||||||
| City: | SEYMOUR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064833807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174173209 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1450 CHAPEL ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065114405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037893000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2021 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2025 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.