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General NPI Number Information
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NPI Number | 1356685911
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Entity Type | Individual
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Provider Name | JON ALAN UMLAUF DPT
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Gender | Male
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 3551 ROGER BROOKE DR
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 757-619-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 7836 RIORDAN ST
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City | FORT MEADE
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State | MD
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Zip | 20755-1139
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Country | US
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Telephone | 757-619-1119
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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 | 24262
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License Number State | MD
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