Basic Information
| Provider Information | |||||||||
| NPI: | 1003018508 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MICHELINI | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | MS, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7932 SW 82ND DR | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326089532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526926430 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 121 GALE LEMERAND DRIVE | ||||||||
| Address2: | UNIVERSITY ATHLETIC ASSOCIATION | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326042485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526926430 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 12/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | AL3772 | FL | Y | Other Service Providers | Specialist |
No ID Information.