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General NPI Number Information
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NPI Number | 1235647413
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Entity Type | Individual
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Provider Name | PAUL ANTON ERNANDES JR. PT
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Gender | Male
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 04/27/2018
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Provider Practice Location Address
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Address Line | 465 MARINER BLVD
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City | SPRING HILL
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State | FL
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Zip | 34609-5680
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Country | US
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Telephone | 352-688-8066
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Fax | 352-688-8540
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Provider Business Mailing Address
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Address Line | 15468 DURANGO CIR
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City | BROOKSVILLE
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State | FL
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Zip | 34604-5009
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Country | US
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Telephone | 352-586-5311
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Fax | 352-688-8540
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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 | PT6556
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License Number State | FL
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