Healthcare Provider Details

I. General information

NPI: 1083117519
Provider Name (Legal Business Name): JENNIFER CASWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W NORTH BLVD STE D
LEESBURG FL
34748-5000
US

IV. Provider business mailing address

600 W NORTH BLVD STE D
LEESBURG FL
34748-5000
US

V. Phone/Fax

Practice location:
  • Phone: 352-787-9300
  • Fax: 352-787-4522
Mailing address:
  • Phone: 352-787-9300
  • Fax: 352-787-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA28321
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: