Provider Demographics
NPI:1376221382
Name:CONCEPCION, RENE DANIEL JR (PTA)
Entity Type:Individual
Prefix:MR
First Name:RENE
Middle Name:DANIEL
Last Name:CONCEPCION
Suffix:JR
Gender:M
Credentials:PTA
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2888 RINGLING BLVD UNIT CD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-5331
Mailing Address - Country:US
Mailing Address - Phone:941-413-5100
Mailing Address - Fax:941-388-7292
Practice Address - Street 1:2888 RINGLING BLVD UNIT CD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5331
Practice Address - Country:US
Practice Address - Phone:941-413-5100
Practice Address - Fax:941-388-7292
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPTA32677225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant