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NPI Code Detail

MEDICARE: MR. JASON JEREMY WEBER PTA

MEDICARE: MR. JASON JEREMY WEBER 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
1225200000XPhysical Therapy AssistantPTA20342FL

General Provider Information

NPI Number : 1992079792
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JASON JEREMY WEBER PTA
Provider Business Mailing Address
First Line : 337 37TH ST S
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33711-1601
Country : US
Telephone Number : 727-518-4757
Fax Number :
Provider Business Practice Location Address
First Line : 4250 66TH ST N
Second Line :
City : KENNETH CITY
State : FL
Zip : 33709-4918
Country : US
Telephone Number : 727-546-2405
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2012
Last Update Date : 02/27/2012

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