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Individual
JASON M WAMBOLD
Active
Individual
JASON M WAMBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
028339
NY
2251X0800X
Orthopedic Physical Therapist
013146
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
028339
LICENSE
NY
Enumeration date
07/19/2006
Last updated
09/24/2013
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