Basic Information
| Provider Information | |||||||||
| NPI: | 1306973854 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | QUITOS | ||||||||
| FirstName: | JASON | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8280 MARA VISTA CT | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328274938 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3303 S SEMORAN BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328222500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072810228 | ||||||||
| FaxNumber: | 4072810229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA18705 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.