Provider Demographics
NPI:1437426558
Name:SUTHERLAND, JASON FLOYD (LMT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:FLOYD
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 LONGWOOD LAKE MARY RD
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3512
Mailing Address - Country:US
Mailing Address - Phone:407-302-5552
Mailing Address - Fax:407-302-5556
Practice Address - Street 1:2009 LONGWOOD LAKE MARY RD
Practice Address - Street 2:SUITE 1001
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-3512
Practice Address - Country:US
Practice Address - Phone:407-302-5552
Practice Address - Fax:407-302-5556
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47995225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist