Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 16367 | NY |
N | 2251G0304X | Physical Therapist - Geriatrics | 16367 | NY |
N | 2251S0007X | Physical Therapist - Sports | 16367 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 16367 | NY |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT36300 | FL |
NPI | 1316922297 |
---|---|
Provider Name | Mr. Michael Ernest Jocson |
First Address | Clermont, FL 34711-5343 |
Second Address | Clermont, FL 34711-3001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 03/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P36828 | (02) | NY |