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NPI Code Detail

MEDICARE: DR. JONATHAN ELGARICO DOLUTAN PT, DPT, DIP. MDT

MEDICARE: DR. JONATHAN ELGARICO DOLUTAN PT, DPT, DIP. MDT
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
1225100000XPhysical Therapist4924SC
2225100000XPhysical Therapist24634FL

General Provider Information

NPI Number : 1982786505
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN ELGARICO DOLUTAN PT, DPT, DIP. MDT
Provider Business Mailing Address
First Line : 25002 HYDE PARK BLVD
Second Line :
City : LAND O LAKES
State : FL
Zip : 34639
Country : US
Telephone Number : 843-343-7000
Fax Number :
Provider Business Practice Location Address
First Line : 2600 BRUCE B DOWNS BLVD
Second Line :
City : WESLEY CHAPEL
State : FL
Zip : 33544-9207
Country : US
Telephone Number : 813-929-5407
Fax Number : 813-929-5293
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 07/21/2022

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