Ivan Slaughter, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA30779 Issued in FL

Practice address

2202 W Oak Ave
Plant City, FL 33563-7222

Phone

(813) 754-3761

NPI assigned

Mar 17, 2021

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1615939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1497330765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6898 A C SKINNER PKWY UNIT 318",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322567929",
            "telephone_number": "904-442-3629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 W OAK AVE",
            "city": "PLANT CITY",
            "state": "FL",
            "postal_code": "335637222",
            "telephone_number": "813-754-3761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLAUGHTER",
        "first_name": "IVAN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-17",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA30779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sharon Jeanne Slabic, APRN
• Cynthia Slapak
• Steven Roy Slavkin, D.D.S.
• Austin James Smith
• Jane McDowell Smith, OTR
• Lori Ann Smith, ARNP
• Stacee Williams Smith, M.S., SLP

• Physical Therapy Assistant in Plant City, FL
• Providers in Plant City, 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 Mar 17, 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.