Provider Demographics
NPI:1861428120
Name:TITSWORTH, J R (ATC, LAT, LPTA)
Entity type:Individual
Prefix:MR
First Name:J
Middle Name:R
Last Name:TITSWORTH
Suffix:
Gender:M
Credentials:ATC, LAT, LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 BOBWHITE CT
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-8806
Mailing Address - Country:US
Mailing Address - Phone:352-583-0659
Mailing Address - Fax:
Practice Address - Street 1:5007 BOBWHITE CT
Practice Address - Street 2:38652 SR 52 , PHS DADE CITY FL 33525
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-8806
Practice Address - Country:US
Practice Address - Phone:352-583-0659
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer