Individual ProviderJason P KellyMassage TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address709 N Main St, North Syracuse, NY 13212-1669(315) 459-4549PECOS EnrollmentBased on the most recent information from CMS, provider Jason P Kelly does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1811452378Provider TypeIndividualFull NameKelly, Jason PTitleMr.CredentialLMTGenderMaleSole ProprietorYesEnumeration Date2/8/2019Last Updated2/8/2019Contact InformationPractice LocationPractice Address709 N Main St, North Syracuse, NY 13212-1669Phone(315) 459-4549FaxUnlisted FaxMailing LocationMailing Address709 N Main St, North Syracuse, NY 13212-1669Phone(315) 459-4549FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225700000XPrimaryDescriptionMassage TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense021332-1New YorkProvider IdentifiersIDDescriptionIssuerID9286674DescriptionOtherIssuerVA PROGRAMNew York