Individual
JERRY G COUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
299 FAREHAM DR, VENICE, FL 34293-4477
(937) 824-0660
Mailing address
299 FAREHAM DR, VENICE, FL 34293-4477
(937) 824-0660
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
23311
FL
Other
Enumeration date
01/26/2023
Last updated
01/26/2023
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