Individual
MR. GRANT JASON CARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
19879 5TH STREET, BEND, OR 97703
(541) 588-2646
(541) 610-1666
Mailing address
19879 5TH STREET, BEND, OR 97703
(541) 588-2646
(541) 610-1666
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5298
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278526
—
OR
Enumeration date
07/31/2006
Last updated
01/09/2020
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