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Individual

AUSTIN ETHERIDGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
619 S MARION AVE, LAKE CITY, FL 32025-5808
(386) 755-3016
Mailing address
51 NW 5TH PL, WILLISTON, FL 32696-1611
(352) 235-0431

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA28949
FL

Other

Enumeration date
04/03/2023
Last updated
04/03/2023
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