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General NPI Number Information
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NPI Number | 1144888678
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Entity Type | Individual
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Provider Name | JED DELLUMES TOBOSO PT
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Gender | Male
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 24151 BEATRIX BLVD UNIT 1107
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City | PORT CHARLOTTE
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State | FL
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Zip | 33954-3864
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Country | US
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Telephone | 662-770-9804
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 PATRIOT COMMONS RD
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City | ABILENE
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State | TX
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Zip | 79601-4709
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Country | US
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Telephone | 662-770-9804
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 34444
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License Number State | FL
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