Basic Information
| Provider Information | |||||||||
| NPI: | 1003016510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TROJACEK | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | WAYNE | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1023 N. ELLIS | ||||||||
| Address2: | |||||||||
| City: | GROESBECK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547290323 | ||||||||
| FaxNumber: | 2547290328 | ||||||||
| Practice Location | |||||||||
| Address1: | 1023 N. ELLIS | ||||||||
| Address2: | |||||||||
| City: | GROESBECK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547290323 | ||||||||
| FaxNumber: | 2547290328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2007 | ||||||||
| LastUpdateDate: | 12/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/27/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1144632 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251P0200X | 1144632 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | 2251S0007X | 1144632 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | 2251X0800X | 1144632 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.