Provider Demographics
NPI:1831732379
Name:CENTURION, JADE KIMBERLY (PT, DPT)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:KIMBERLY
Last Name:CENTURION
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12337 WYNNFIELD LAKES DR UNIT 524
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-4253
Mailing Address - Country:US
Mailing Address - Phone:407-575-4857
Mailing Address - Fax:
Practice Address - Street 1:463646 STATE ROAD 200 STE 4
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-0303
Practice Address - Country:US
Practice Address - Phone:904-261-4414
Practice Address - Fax:904-261-4614
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist