Provider Demographics
NPI:1578657235
Name:KOMBRINCK, JASON BRUCE (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:BRUCE
Last Name:KOMBRINCK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:
Other - Last Name:KOMBRINCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:40 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8408
Mailing Address - Country:US
Mailing Address - Phone:727-345-3346
Mailing Address - Fax:727-345-3595
Practice Address - Street 1:3690 E BAY DR STE S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-1946
Practice Address - Country:US
Practice Address - Phone:727-532-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30744225100000X
FLPT20514225100000X
WYPT-1311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist