Provider Demographics
NPI:1467119206
Name:JAASKO, NILS-OTTO (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:NILS-OTTO
Middle Name:
Last Name:JAASKO
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24600 S TAMIAMI TRL STE 212
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7023
Mailing Address - Country:US
Mailing Address - Phone:239-324-6824
Mailing Address - Fax:
Practice Address - Street 1:9119 ESTERO RIVER CIR
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-4416
Practice Address - Country:US
Practice Address - Phone:239-324-6824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-28
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL36010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist