MEDICARE: WILDFLOWER PEDIATRIC THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	225100000X	Physical Therapist
3	225X00000X	Occupational Therapist
4	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1255185765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILDFLOWER PEDIATRIC THERAPY

Provider Business Mailing Address
First Line	:	85313 HARTS RD
Second Line	:
City	:	YULEE
State	:	FL
Zip	:	32097-3892
Country	:	US
Telephone Number	:	904-468-5124
Fax Number	:	904-990-1356

Provider Business Practice Location Address
First Line	:	10373 BIG TREE CIR E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-6356
Country	:	US
Telephone Number	:	904-874-0263
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DR. ALEXIS NICOLE MYERS
Credential	:	DPT
Telephone Number	:	904-874-0263

Provider Enumeration Date	:	04/12/2024
Last Update Date	:	04/14/2026

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Directions to “WILDFLOWER PEDIATRIC THERAPY ” Practice Location

Language	Start Address	Practice Location

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