Provider Demographics
NPI:1326805326
Name:FLORES, JONATHAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:FLORES SANTILLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3763 S KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-7412
Mailing Address - Country:US
Mailing Address - Phone:928-446-0363
Mailing Address - Fax:
Practice Address - Street 1:13645 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33181-1617
Practice Address - Country:US
Practice Address - Phone:305-949-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT414042251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic