Provider Demographics
NPI:1003018508
Name:MICHELINI, JON PAUL (MS, ATC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:PAUL
Last Name:MICHELINI
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7932 SW 82ND DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-9532
Mailing Address - Country:US
Mailing Address - Phone:352-692-6430
Mailing Address - Fax:
Practice Address - Street 1:121 GALE LEMERAND DRIVE
Practice Address - Street 2:UNIVERSITY ATHLETIC ASSOCIATION
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32604-2485
Practice Address - Country:US
Practice Address - Phone:352-692-6430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL3772174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist