Healthcare Provider Details

I. General information

NPI: 1942572755
Provider Name (Legal Business Name): PAUL JOHN CHAPMAN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12170 CORTEZ BLVD
BROOKSVILLE FL
34613-5578
US

IV. Provider business mailing address

10101 BRIAR CIR
HUDSON FL
34667-6653
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-5100
  • Fax:
Mailing address:
  • Phone: 727-267-1636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number20224 PTA
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: