Provider Demographics
NPI:1922440932
Name:DEAN, JEFFREY ALAN
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:DEAN
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 1:3201 NE 5TH CT
Mailing Address - Street 2:#3
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4749
Mailing Address - Country:US
Mailing Address - Phone:954-857-7600
Mailing Address - Fax:
Practice Address - Street 1:4200 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-7353
Practice Address - Country:US
Practice Address - Phone:954-981-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24121225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant