Healthcare Provider Details

I. General information

NPI: 1477401743
Provider Name (Legal Business Name): VA PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 3RD ST N
JACKSONVILLE BEACH FL
32250-7152
US

IV. Provider business mailing address

931 3RD ST N
JACKSONVILLE BEACH FL
32250-7152
US

V. Phone/Fax

Practice location:
  • Phone: 904-605-0790
  • Fax: 904-209-9482
Mailing address:
  • Phone: 904-605-0790
  • Fax: 904-209-9482

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: VICTORIA HERNANDEZ ADEEB
Title or Position: OWNER
Credential:
Phone: 904-605-0790