1023574274 NPI number — CHRISTOPHER COLON JAIME DPT,PT

Table of content: CHRISTOPHER COLON JAIME DPT,PT (NPI 1023574274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023574274 NPI number — CHRISTOPHER COLON JAIME DPT,PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAIME
Provider First Name:
CHRISTOPHER
Provider Middle Name:
COLON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT,PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023574274
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 LEXINGTON GREEN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANFORD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32771-1013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-322-3442
Provider Business Mailing Address Fax Number:
407-322-8404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
290 CLYDE MORRIS BLVD STE A1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174-8204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-898-0443
Provider Business Practice Location Address Fax Number:
386-898-0459
Provider Enumeration Date:
02/13/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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