Healthcare Provider Details

I. General information

NPI: 1013064484
Provider Name (Legal Business Name): JAMES R JONES PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S ORLANDO AVE STE H
WINTER PARK FL
32789-7102
US

IV. Provider business mailing address

4021 IBIS DR
ORLANDO FL
32803-3005
US

V. Phone/Fax

Practice location:
  • Phone: 407-628-5500
  • Fax: 407-628-5505
Mailing address:
  • Phone: 407-579-6821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA#13902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: