Healthcare Provider Details

I. General information

NPI: 1730003328
Provider Name (Legal Business Name): FANTICOUS C MCNAIR PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 SW ARCHER RD
GAINESVILLE FL
32608-1316
US

IV. Provider business mailing address

3740 WALNUT ST
JACKSONVILLE FL
32206-1475
US

V. Phone/Fax

Practice location:
  • Phone: 352-554-2000
  • Fax:
Mailing address:
  • Phone: 904-416-4574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT45140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: