MEDICARE: TAWANA NEAL 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	PTA27671	FL

General Provider Information

NPI Number	:	1336087865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAWANA NEAL PTA

Provider Business Mailing Address
First Line	:	2298 NETTLEBROOK ST S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-1008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2298 NETTLEBROOK ST S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-1008
Country	:	US
Telephone Number	:	904-803-8356
Fax Number	:

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

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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