Healthcare Provider Details

I. General information

NPI: 1942017371
Provider Name (Legal Business Name): JANA MARIE MOTES PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14114 ALABAMA ST
JAY FL
32565-1219
US

IV. Provider business mailing address

14114 ALABAMA ST
JAY FL
32565-1219
US

V. Phone/Fax

Practice location:
  • Phone: 448-227-5840
  • Fax: 850-675-8016
Mailing address:
  • Phone: 448-227-5840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number33627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: