Provider Demographics
NPI:1235647413
Name:ERNANDES, PAUL ANTON JR (PT)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANTON
Last Name:ERNANDES
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:15468 DURANGO CIR
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-5009
Mailing Address - Country:US
Mailing Address - Phone:352-586-5311
Mailing Address - Fax:352-688-8540
Practice Address - Street 1:465 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5680
Practice Address - Country:US
Practice Address - Phone:352-688-8066
Practice Address - Fax:352-688-8540
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT6556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist