Javonte Fredericks

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

PTA30943 Issued in FL

Practice address

535 One Center Blvd Apt 208
Altamonte Springs, FL 32701-2240

Phone

(321) 202-1749

NPI assigned

Mar 28, 2021

Last updated

Mar 28, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1616889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616889600000",
    "number": "1285211847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 ONE CENTER BLVD APT 208",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327012240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 ONE CENTER BLVD APT 208",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327012240",
            "telephone_number": "321-202-1749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKS",
        "first_name": "JAVONTE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-28",
        "last_updated": "2021-03-28",
        "certification_date": "2021-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "FL",
            "license": "PTA30943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Francisco P Carreon MD PA
• Timarie Anne Franco
• Kelly Frank, PT, DPT
• Sabrina Frank, MA, BCBA
• Frederick M Vanderschaaf DC PA (VanderSchaaf Chiropractic Clinic)
• Fresenius Medical Care Casselberry, LLC (Fresenius Kidney Care Orlando)
• Fresenius Medical Care Casselberry, LLC (Fresenius Kidney Care North Orlando)
• Robyn Frost
• Eliam Manuel Fuentes Tirado, M.D.
• Dayanara Fuentes

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Altamonte Springs, FL
• Providers in Altamonte Springs, FL by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2021; 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.