Provider Demographics
NPI:1417056003
Name:OVERSTREET, JEFFREY (PTA LMT FT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:OVERSTREET
Suffix:
Gender:M
Credentials:PTA LMT FT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8294
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33482-8294
Mailing Address - Country:US
Mailing Address - Phone:561-495-4917
Mailing Address - Fax:
Practice Address - Street 1:5132 CONKLIN DR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-2616
Practice Address - Country:US
Practice Address - Phone:561-495-4917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-A017145225200000X
FLMA 38091225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist