Healthcare Provider Details

I. General information

NPI: 1073852414
Provider Name (Legal Business Name): ERIC JONES PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18480 COCHRAN BLVD
PORT CHARLOTTE FL
33948-3379
US

IV. Provider business mailing address

4041 TAGGART CAY N #303
SARASOTA FL
34233
US

V. Phone/Fax

Practice location:
  • Phone: 941-743-4700
  • Fax:
Mailing address:
  • Phone: 941-685-4499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA23569
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: