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Individual
JASON RIVERS
Active
Individual
JASON RIVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
1334935
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W255323105
AETNA
—
Enumeration date
02/08/2022
Last updated
02/08/2022
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