Provider Demographics
NPI:1104206705
Name:HOWARD, JEREMY DANIEL (ATC, CES, PES)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:DANIEL
Last Name:HOWARD
Suffix:
Gender:M
Credentials:ATC, CES, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17460 ORIOLE RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-5104
Mailing Address - Country:US
Mailing Address - Phone:239-898-9131
Mailing Address - Fax:
Practice Address - Street 1:28811 S TAMIAMI TRL
Practice Address - Street 2:SUITE #13
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-3201
Practice Address - Country:US
Practice Address - Phone:239-221-7123
Practice Address - Fax:239-221-7987
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer