Healthcare Provider Details

I. General information

NPI: 1326845330
Provider Name (Legal Business Name): JEAN CIVIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4197 EDENROCK PL
SPRING HILL FL
34609-0620
US

IV. Provider business mailing address

4197 EDENROCK PL
SPRING HILL FL
34609-0620
US

V. Phone/Fax

Practice location:
  • Phone: 727-254-0659
  • Fax:
Mailing address:
  • Phone: 727-254-0659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA28530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: