Healthcare Provider Details

I. General information

NPI: 1801360342
Provider Name (Legal Business Name): DUBLAIN COULANGES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S PINE ST
SEBRING FL
33870-3654
US

IV. Provider business mailing address

129 SANDERLING DR
HAINES CITY FL
33844-8233
US

V. Phone/Fax

Practice location:
  • Phone: 863-385-0161
  • Fax:
Mailing address:
  • Phone: 863-353-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number27896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: