Provider Demographics
NPI:1336321579
Name:FRANK, JASON K (PTA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:K
Last Name:FRANK
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 1:2440 ORMSBY CIR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-3928
Mailing Address - Country:US
Mailing Address - Phone:707-481-5112
Mailing Address - Fax:
Practice Address - Street 1:2440 ORMSBY CIR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3928
Practice Address - Country:US
Practice Address - Phone:707-481-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT8472225200000X
FL22048225200000X
TX2075613225200000X
IL160.006036225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant