Provider Demographics
NPI:1275644205
Name:REED, JONATHAN F (PTA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:F
Last Name:REED
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1478
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:FL
Mailing Address - Zip Code:32187-1478
Mailing Address - Country:US
Mailing Address - Phone:386-698-4720
Mailing Address - Fax:386-698-4866
Practice Address - Street 1:405 S SUMMIT ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-3047
Practice Address - Country:US
Practice Address - Phone:386-698-4720
Practice Address - Fax:386-698-4866
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20570225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant