Provider Demographics
NPI:1679322648
Name:FERNHOLZ, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:FERNHOLZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:KERKHOVEN
Mailing Address - State:MN
Mailing Address - Zip Code:56252-9200
Mailing Address - Country:US
Mailing Address - Phone:320-905-3939
Mailing Address - Fax:
Practice Address - Street 1:1801 WILLMAR AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-2882
Practice Address - Country:US
Practice Address - Phone:320-214-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant