Individual
MR. JASON PHILLIP NUSSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
180 TURKEY FARM RD, BLYTHEWOOD, SC 29016-9699
(803) 381-0168
Mailing address
180 TURKEY FARM RD, BLYTHEWOOD, SC 29016-9699
(803) 381-0168
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
858
SC
Other
Enumeration date
02/25/2009
Last updated
12/23/2014
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