Healthcare Provider Details

I. General information

NPI: 1508883018
Provider Name (Legal Business Name): PHYSICAL THERAPY ASSOCIATES OF ORANGE PARK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 BUSINESS CENTER DR STE B
FLEMING ISLAND FL
32003-4416
US

IV. Provider business mailing address

1550 BUSINESS CENTER DR STE B
ORANGE PARK FL
32003-4416
US

V. Phone/Fax

Practice location:
  • Phone: 904-276-7881
  • Fax: 904-276-7568
Mailing address:
  • Phone: 904-276-7881
  • Fax: 904-276-7568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEMANT PATEL
Title or Position: ADMINISTRATOR/OWNER
Credential: PT
Phone: 904-264-6304