Provider Demographics
NPI:1326014473
Name:PABON, JESUS M (PT)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:M
Last Name:PABON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:58 SAINT KITTS CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3500
Mailing Address - Country:US
Mailing Address - Phone:863-325-8233
Mailing Address - Fax:
Practice Address - Street 1:950 1ST ST S
Practice Address - Street 2:SPORTS AND ORTHO REHAB TEAM
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3665
Practice Address - Country:US
Practice Address - Phone:863-293-7778
Practice Address - Fax:863-299-3836
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist