Individual
JASON M LYDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
6701 BERGENLINE AVE, WEST NEW YORK, NJ 07093-1704
(201) 758-9100
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA01752500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40QA01752500
PHYSICAL THERAPY LISCENSE
NJ
Enumeration date
09/08/2017
Last updated
06/13/2024
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