Individual
JASON M VEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1910 BLANDING ST, COLUMBIA, SC 29201-3520
(803) 256-4107
Mailing address
1910 BLANDING ST, COLUMBIA, SC 29201-3520
(803) 256-4107
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5601
SC
225100000X
Physical Therapist
PT2368
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03274724
—
MS
01
—
P00346935
RAILROAD
MS
Enumeration date
07/17/2006
Last updated
07/21/2022
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