Provider Demographics
NPI:1043750219
Name:VENARCHICK, JONATHAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:VENARCHICK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15751 SAN CARLOS BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3314
Mailing Address - Country:US
Mailing Address - Phone:239-337-2739
Mailing Address - Fax:239-337-2738
Practice Address - Street 1:15751 SAN CARLOS BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3314
Practice Address - Country:US
Practice Address - Phone:239-337-2739
Practice Address - Fax:239-337-2738
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist