Provider Demographics
NPI:1477907152
Name:JAEGER, KURT ALLEN
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:ALLEN
Last Name:JAEGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3452 LAKE LYNDA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1430
Mailing Address - Country:US
Mailing Address - Phone:407-308-3906
Mailing Address - Fax:877-217-9271
Practice Address - Street 1:3452 LAKE LYNDA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1430
Practice Address - Country:US
Practice Address - Phone:407-308-3906
Practice Address - Fax:877-217-9271
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48001225200000X
TX2107426225200000X
NY009592-1225200000X
PATE010180225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant