Provider Demographics
NPI:1265737191
Name:ENSOR, IRVING HAROLD (PTA)
Entity type:Individual
Prefix:
First Name:IRVING
Middle Name:HAROLD
Last Name:ENSOR
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 1:14235 EDWINOLA WAY
Mailing Address - Street 2:ROOM 831
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-3763
Mailing Address - Country:US
Mailing Address - Phone:352-567-5910
Mailing Address - Fax:352-567-6860
Practice Address - Street 1:8477 S SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-5028
Practice Address - Country:US
Practice Address - Phone:352-382-1141
Practice Address - Fax:352-382-1146
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 22458225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant