Healthcare Provider Details

I. General information

NPI: 1023281946
Provider Name (Legal Business Name): JASON MICHAEL GUYNN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 SE 16TH AVE
OCALA FL
34471-4656
US

IV. Provider business mailing address

4500 W NEWBERRY RD
GAINESVILLE FL
32607-2245
US

V. Phone/Fax

Practice location:
  • Phone: 352-620-1900
  • Fax: 352-620-1901
Mailing address:
  • Phone: 352-336-6000
  • Fax: 352-332-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number19650
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: