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NPI Code Detail

MEDICARE: BETHANY CLUBB PT, DPT

MEDICARE: BETHANY CLUBB PT, DPT
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT41084FL

General Provider Information

NPI Number : 1265206940
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY CLUBB PT, DPT
Provider Business Mailing Address
First Line : 3901 UNIVERSITY BLVD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-4312
Country : US
Telephone Number : 904-345-7251
Fax Number :
Provider Business Practice Location Address
First Line : 104 ASHOURIAN AVE STE 105
Second Line :
City : SAINT AUGUSTINE
State : FL
Zip : 32092-5106
Country : US
Telephone Number : 904-230-7761
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2023
Last Update Date : 11/13/2023

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Directions to “ BETHANY CLUBB PT, DPT” Practice Location

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