Provider Demographics
NPI:1629193537
Name:ONTOG-GOLDEN, JANELLE VALIN (LPTA)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:VALIN
Last Name:ONTOG-GOLDEN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 AVELLA STREET
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954
Mailing Address - Country:US
Mailing Address - Phone:757-232-1696
Mailing Address - Fax:
Practice Address - Street 1:1531 TAMIAMI TRL S STE 702B
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5569
Practice Address - Country:US
Practice Address - Phone:941-266-3978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20678225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant