Provider Demographics
NPI:1396215372
Name:NORTH, JOHNATHAN T (PTA)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:T
Last Name:NORTH
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 1:312 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:FL
Mailing Address - Zip Code:32234-3018
Mailing Address - Country:US
Mailing Address - Phone:904-923-1216
Mailing Address - Fax:
Practice Address - Street 1:8700 A C SKINNER PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0836
Practice Address - Country:US
Practice Address - Phone:904-642-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29075225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant