Provider Demographics
NPI:1073196069
Name:LEDMAN, JASE THOMAS (DPT)
Entity Type:Individual
Prefix:
First Name:JASE
Middle Name:THOMAS
Last Name:LEDMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 PANAMA CITY BEACH PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:941-925-7744
Practice Address - Street 1:13405 PANAMA CITY BEACH PKWY STE A
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2885
Practice Address - Country:US
Practice Address - Phone:850-236-7497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist