Healthcare Provider Details

I. General information

NPI: 1487872651
Provider Name (Legal Business Name): NASSAU PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45390 GREEN AVE
CALLAHAN FL
32011-3711
US

IV. Provider business mailing address

PO BOX 1609
CALLAHAN FL
32011-1609
US

V. Phone/Fax

Practice location:
  • Phone: 904-879-1223
  • Fax: 904-879-1223
Mailing address:
  • Phone: 904-879-1223
  • Fax: 904-879-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT 5539
License Number StateFL

VIII. Authorized Official

Name: MRS. SHARON MARINO
Title or Position: OFFICE MANAGER
Credential:
Phone: 904-277-4449