Healthcare Provider Details

I. General information

NPI: 1619933017
Provider Name (Legal Business Name): JASON E HYDER MPT,OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 S PATRICK DR STE 3
INDIAN HARBOUR BEACH FL
32937-4400
US

IV. Provider business mailing address

2030 S PATRICK DR STE 3
INDIAN HARBOUR BEACH FL
32937-4400
US

V. Phone/Fax

Practice location:
  • Phone: 321-773-8155
  • Fax: 321-773-8154
Mailing address:
  • Phone: 321-773-8155
  • Fax: 321-773-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number40QA01126700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA01126700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT22704
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT22704
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: