Provider Demographics
NPI:1730300088
Name:VENTURA, JAN DERRICK DUBLIN (PT)
Entity Type:Individual
Prefix:
First Name:JAN DERRICK
Middle Name:DUBLIN
Last Name:VENTURA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 LICOLN ROAD NORTH EAST
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852
Mailing Address - Country:US
Mailing Address - Phone:561-706-6132
Mailing Address - Fax:
Practice Address - Street 1:6120 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1221
Practice Address - Country:US
Practice Address - Phone:863-471-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 23245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist