Basic Information
| Provider Information | |||||||||
| NPI: | 1801205596 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VINSON | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1743 CLIFF GOOKIN BLVD | ||||||||
| Address2: | |||||||||
| City: | TUPELO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388016723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6626805216 | ||||||||
| FaxNumber: | 6626805217 | ||||||||
| Practice Location | |||||||||
| Address1: | 1743 CLIFF GOOKIN BLVD | ||||||||
| Address2: | |||||||||
| City: | TUPELO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388016723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6626805216 | ||||||||
| FaxNumber: | 6626805217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2014 | ||||||||
| LastUpdateDate: | 08/06/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT5595 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.