MEDICARE: MR. JASON QUITOS PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA18705	FL

General Provider Information

NPI Number	:	1306973854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON QUITOS PTA

Provider Business Mailing Address
First Line	:	8280 MARA VISTA CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-4938
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3303 S SEMORAN BLVD
Second Line	:	SUITE 300
City	:	ORLANDO
State	:	FL
Zip	:	32822-2500
Country	:	US
Telephone Number	:	407-281-0228
Fax Number	:	407-281-0229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. JASON QUITOS PTA” Practice Location

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