Healthcare Provider Details

I. General information

NPI: 1013606334
Provider Name (Legal Business Name): JASON TEJANO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7740 PRESERVE LN STE 5
NAPLES FL
34119-9710
US

IV. Provider business mailing address

25241 ELEMENTARY WAY STE 200
BONITA SPRINGS FL
34135-7883
US

V. Phone/Fax

Practice location:
  • Phone: 239-227-2297
  • Fax: 239-228-4878
Mailing address:
  • Phone: 239-947-4184
  • Fax: 239-947-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-07359
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT41669
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: