Jerry G Couch, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

23311 Issued in FL

Practice address

299 Fareham Dr
Venice, FL 34293-4477

Phone

(937) 824-0660

NPI assigned

Jan 26, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• S N J Simply Fit

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Venice, FL
  • NPI 1760189583
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1083320642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "299 FAREHAM DR",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342934477",
            "telephone_number": "937-824-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "299 FAREHAM DR",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342934477",
            "telephone_number": "937-824-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUCH",
        "first_name": "JERRY",
        "middle_name": "G",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-26",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "23311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia Brooke Cossentino, L.M.T
• Costco Wholesale Corporation (Costco Optical #1682)
• Costco Wholesale Corporation (Costco Hearing Aid #1682)
• Costco Wholesale Corporation (Costco Pharmacy 1682)
• William J Cottone, O.D.
• Sandy Ruth Couch
• Country Club PT PA
• Sarah M Courtney, MSN, APRN, FNP
• Theresa Ann Croce Benedict, LCSW
• CSH-Ing Bella Vita LP (Bella Vita Venice)

• Physical Therapy Assistant in Venice, FL
• Providers in Venice, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.