Provider Demographics
NPI:1083376172
Name:ZHENG, JINGYAO (LAT,ATC, LMT)
Entity type:Individual
Prefix:
First Name:JINGYAO
Middle Name:
Last Name:ZHENG
Suffix:
Gender:M
Credentials:LAT,ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 TURKEY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-8550
Mailing Address - Country:US
Mailing Address - Phone:904-868-8118
Mailing Address - Fax:
Practice Address - Street 1:3351 HENDRICKS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5301
Practice Address - Country:US
Practice Address - Phone:904-402-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA94716225700000X
FLAL45322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist