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General NPI Number Information
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NPI Number | 1144808536
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Entity Type | Individual
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Provider Name | JONATHAN DUBBANEH PTA
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Gender | Male
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 2888 RINGLING BLVD UNIT CD
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City | SARASOTA
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State | FL
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Zip | 34237-5331
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Country | US
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Telephone | 941-413-5100
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Fax | 941-388-7292
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Provider Business Mailing Address
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Address Line | 4405 BANYAN TREE PL
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City | RIVERVIEW
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State | FL
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Zip | 33578-3039
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Country | US
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Telephone | 941-268-5809
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 25514
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License Number State | FL
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