Provider Demographics
NPI:1023058500
Name:SLOOTS, JOHAN (PT)
Entity type:Individual
Prefix:MR
First Name:JOHAN
Middle Name:
Last Name:SLOOTS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7544 JACQUE ROAD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667
Mailing Address - Country:US
Mailing Address - Phone:727-697-2200
Mailing Address - Fax:727-863-8774
Practice Address - Street 1:7544 JACQUE ROAD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-697-2200
Practice Address - Fax:727-863-8774
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0613080001Medicare NSC
FLY6777ZMedicare PIN
FLP00282328Medicare PIN