Provider Demographics
NPI:1427488584
Name:BENN, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BENN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N ALAFAYA TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4726
Mailing Address - Country:US
Mailing Address - Phone:407-380-8705
Mailing Address - Fax:407-643-2804
Practice Address - Street 1:1900 N ALAFAYA TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4726
Practice Address - Country:US
Practice Address - Phone:407-380-8705
Practice Address - Fax:407-643-2804
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27566225100000X, 2251X0800X, 225100000X
COAT.00014782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer