Provider Demographics
NPI:1831567072
Name:HOUCK, JERI LYNN (PT)
Entity type:Individual
Prefix:
First Name:JERI LYNN
Middle Name:
Last Name:HOUCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 PINEHURST RD
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5427
Mailing Address - Country:US
Mailing Address - Phone:727-734-1901
Mailing Address - Fax:727-342-7335
Practice Address - Street 1:1112 PINEHURST RD
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5427
Practice Address - Country:US
Practice Address - Phone:727-734-1901
Practice Address - Fax:727-342-7335
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 3765OtherLICENSE
FLII883ZMedicare PIN