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General NPI Number Information
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NPI Number | 1447025937
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Entity Type | Individual
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Provider Name | JERMAINE DONSON PTA, WCC
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Gender | Male
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 233 CARMEL DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-1957
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Country | US
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Telephone | 850-864-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 405 PARISH CV
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City | MARY ESTHER
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State | FL
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Zip | 32569-2134
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Country | US
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Telephone | 850-499-5480
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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 | PTA31237
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License Number State | FL
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