Individual
MR. ETHAN E DUPONT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
7350 DAIRY RD, ZEPHYRHILLS, FL 33540
(813) 788-4300
Mailing address
14107 JIM HUNT RD, CLERMONT, FL 34715
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
27683
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
959213424
UNITED HEALTH CARE
FL
Enumeration date
10/05/2017
Last updated
10/05/2017
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