Healthcare Provider Details

I. General information

NPI: 1366326217
Provider Name (Legal Business Name): ETHAN TRIPLETT PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17313 PAGONIA RD BLDG N
CLERMONT FL
34711-5940
US

IV. Provider business mailing address

17313 PAGONIA RD BLDG N
CLERMONT FL
34711-5940
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-2862
  • Fax: 352-394-2861
Mailing address:
  • Phone: 352-394-2862
  • Fax: 352-394-2861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42680
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: