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Individual

ETHAN O'HEARN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
1586 BLOOMINGDALE AVE, VALRICO, FL 33596-6101
(813) 978-9700
(813) 558-6001
Mailing address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0915
(813) 978-9700
(813) 558-6001

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA29120
FL

Other

Enumeration date
07/26/2024
Last updated
07/26/2024
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