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General NPI Number Information
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NPI Number | 1437699352
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Entity Type | Individual
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Provider Name | DUSTIN AUDET PTA
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Gender | Male
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 8080 SUMMER COVE CT
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City | JACKSONVILLE
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State | FL
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Zip | 32256-3940
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Country | US
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Telephone | 352-219-8533
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Fax |
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Provider Business Mailing Address
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Address Line | 8080 SUMMER COVE CT
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City | JACKSONVILLE
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State | FL
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Zip | 32256-3940
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Country | US
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Telephone | 352-219-8533
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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 | PTA27307
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License Number State | FL
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