Jaesen Petretta Inc

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

License

OT10199 Issued in FL

Legal business name

JAESEN PETRETTA INC

Practice address

12995 S Cleveland Ave Ste 158
Fort Myers, FL 33907-3867

Phone

(239) 839-3408

NPI assigned

Jun 28, 2013

Organization subpart

No

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

Authorized official

Name

Jaesen Petretta, OTR/L

Title

President

Phone

(239) 839-3408

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1372377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372377600000",
    "number": "1487094983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4281 7TH AVE SW",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341194029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12995 S CLEVELAND AVE STE 158",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073867",
            "telephone_number": "239-839-3408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAESEN PETRETTA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-28",
        "last_updated": "2013-06-28",
        "status": "A",
        "authorized_official_last_name": "PETRETTA",
        "authorized_official_first_name": "JAESEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-839-3408",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "FL",
            "license": "OT10199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert G Jacoby, M.D.
• Mario Jacome Jr., DO
• Tomas Jacome, MD
• Jahan Jadauji, M.D.
• Jade Clinic Family and Wellness Center Corp
• Christine M Jaffe, CPNP, MS, RN
• Nicole Ann Jaffe, PH.D.
• Jeanne Ann Jagodzinski, PMHNP-BC
• Ahmed I Jakda, MD
• Julie Ann Jakobi, RMHCI

• Rehabilitation Clinic/Center in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Rehabilitation Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2013; 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.