Healthcare Provider Details

I. General information

NPI: 1629742622
Provider Name (Legal Business Name): JOCSON PHYSICAL THERAPY & TRAINING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 4TH ST
CLERMONT FL
34711-3001
US

IV. Provider business mailing address

4005 BEACON RIDGE WAY
CLERMONT FL
34711-5343
US

V. Phone/Fax

Practice location:
  • Phone: 352-404-7676
  • Fax:
Mailing address:
  • Phone: 718-219-5560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JOCSON
Title or Position: OWNER
Credential: PT
Phone: 718-219-5560