Provider Demographics
NPI:1679032346
Name:MCCHESNEY, JONATHAN (PTA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:MCCHESNEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 GANDY BLVD N APT 1328
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2352
Mailing Address - Country:US
Mailing Address - Phone:301-351-8909
Mailing Address - Fax:
Practice Address - Street 1:5165 34TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-4515
Practice Address - Country:US
Practice Address - Phone:727-867-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant