Basic Information
| Provider Information | |||||||||
| NPI: | 1912112814 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURUD | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | P.T.,D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1609 29TH AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581035922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012418516 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 32ND AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581035800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012348700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 09/08/2008 | ||||||||
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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 | 2251S0007X | 952 | ND | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
No ID Information.