MEDICARE: ETHAN TRIPLETT PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT42680	FL

General Provider Information

NPI Number	:	1366326217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN TRIPLETT PT, DPT

Provider Business Mailing Address
First Line	:	17313 PAGONIA RD BLDG N
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5940
Country	:	US
Telephone Number	:	352-394-2862
Fax Number	:	352-394-2861

Provider Business Practice Location Address
First Line	:	17313 PAGONIA RD BLDG N
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5940
Country	:	US
Telephone Number	:	352-394-2862
Fax Number	:	352-394-2861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	12/15/2025

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