Doctor Name: | JASON DERIC LEBEL |
NPI Number: | 1982905972 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | PT-2439 |
Business Practice Address: | 4650 Hawthorne Rd Suite 2b Pocatello, ID - 832022376 |
Business Phone Number: | 2082216952 |
Business Fax Number: | 2082383349 |
Mailing Address: | 9417 N Connell Rd, POCATELLO |
State: | ID |
Postal Code: | 832019057 |
Phone Number: | 2084067975 |
Fax Number: | |
NPI Enumeration Date: | 11/08/2010 |
NPI Last Update Date: | 11/08/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT-2439 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |