Provider Demographics
NPI:1447025937
Name:DONSON, JERMAINE (PTA, WCC)
Entity type:Individual
Prefix:
First Name:JERMAINE
Middle Name:
Last Name:DONSON
Suffix:
Gender:M
Credentials:PTA, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 PARISH CV
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-2134
Mailing Address - Country:US
Mailing Address - Phone:850-499-5480
Mailing Address - Fax:
Practice Address - Street 1:233 CARMEL DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1957
Practice Address - Country:US
Practice Address - Phone:850-864-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA31237225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant