Provider Demographics
NPI:1942572755
Name:CHAPMAN, PAUL JOHN (PTA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOHN
Last Name:CHAPMAN
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 1:10101 BRIAR CIR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6653
Mailing Address - Country:US
Mailing Address - Phone:727-267-1636
Mailing Address - Fax:
Practice Address - Street 1:12170 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5578
Practice Address - Country:US
Practice Address - Phone:352-597-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20224 PTA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant