| Ethos Health Daytona, Llc | |
|
325 N Williamson Blvd Daytona Beach FL 32114-8171 | |
| (352) 732-5590 | |
| (352) 732-0292 |
| Full Name | Ethos Health Daytona, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 325 N Williamson Blvd, Daytona Beach, Florida |
| Authorized Official Name and Position | Jonathan Ray Walker (OWNER/OPERATOR) |
| Authorized Official Contact | 5273255903 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ethos Health Daytona, Llc 1541 Se 17th St Ocala FL 34471-4607 Ph: (352) 732-5590 | Ethos Health Daytona, Llc 325 N Williamson Blvd Daytona Beach FL 32114-8171 Ph: (352) 732-5590 |
| NPI Number | 1780176263 |
|---|---|
| Provider Enumeration Date | 05/31/2018 |
| Last Update Date | 09/03/2021 |
| Medicare PECOS PAC ID | 1658610837 |
|---|---|
| Medicare Enrollment ID | O20190306000359 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780176263 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Michael A Ursillo |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1992889745 PECOS PAC ID: 5496755498 Enrollment ID: I20091219000102 |
| Provider Name | Agnes Torres Lynch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740721695 PECOS PAC ID: 7012278161 Enrollment ID: I20180306000828 |
| Provider Name | Erin M Leegan |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1760890891 PECOS PAC ID: 9830413855 Enrollment ID: I20200507002603 |
| Provider Name | Jennifer Lynn Waicus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417585316 PECOS PAC ID: 0547681785 Enrollment ID: I20200526003023 |
| Provider Name | Victoria Waechter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316512254 PECOS PAC ID: 2466858386 Enrollment ID: I20210901000869 |
| Provider Name | Kyle Jonathon Chacon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457839359 PECOS PAC ID: 4183021884 Enrollment ID: I20220225002467 |
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