| Ethos Health Lakeland, Llc | |
|
625 Commerce Dr Ste 104 Lakeland FL 33813-2733 | |
| (352) 732-5590 | |
| (352) 732-0292 |
| Full Name | Ethos Health Lakeland, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 625 Commerce Dr Ste 104, Lakeland, Florida |
| Authorized Official Name and Position | Jonathan Walker (OWNER/OPERATOR) |
| Authorized Official Contact | 3527325590 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ethos Health Lakeland, Llc 1541 Se 17th St Ocala FL 34471-4607 Ph: (352) 732-5590 | Ethos Health Lakeland, Llc 625 Commerce Dr Ste 104 Lakeland FL 33813-2733 Ph: (352) 732-5590 |
| NPI Number | 1013409598 |
|---|---|
| Provider Enumeration Date | 05/31/2018 |
| Last Update Date | 10/13/2021 |
| Medicare PECOS PAC ID | 1153720750 |
|---|---|
| Medicare Enrollment ID | O20210602001643 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013409598 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Jonathan Ray Walker |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1801092218 PECOS PAC ID: 2062576705 Enrollment ID: I20090205000205 |
| Provider Name | Justine Alexis Nierras |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1164870978 PECOS PAC ID: 8628321486 Enrollment ID: I20181024000430 |
| Provider Name | Winona L Werts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821501982 PECOS PAC ID: 2062766421 Enrollment ID: I20181121001798 |
| Provider Name | Matthew Shanklin |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1588146443 PECOS PAC ID: 5294070728 Enrollment ID: I20190102001939 |
| Provider Name | Heather Watford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255805230 PECOS PAC ID: 7810327251 Enrollment ID: I20200424002871 |
| Provider Name | Kyle Jonathon Chacon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457839359 PECOS PAC ID: 4183021884 Enrollment ID: I20220225002467 |
| Provider Name | Nicole Bozzini |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1770226342 PECOS PAC ID: 8921483421 Enrollment ID: I20220920001929 |
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