Healthcare Provider Details

I. General information

NPI: 1386163855
Provider Name (Legal Business Name): JONATHAN HOULE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10015 TRINITY BLVD
TRINITY FL
34655-4589
US

IV. Provider business mailing address

8103 ROYAL HART DR
NEW PORT RICHEY FL
34653-5054
US

V. Phone/Fax

Practice location:
  • Phone: 727-203-3760
  • Fax:
Mailing address:
  • Phone: 727-514-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000015008
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT36604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: