Healthcare Provider Details

I. General information

NPI: 1104867670
Provider Name (Legal Business Name): JANET S MOULTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 16TH AVE N STE B
JACKSONVILLE BEACH FL
32250-4819
US

IV. Provider business mailing address

340 16TH AVE N STE B
JACKSONVILLE BEACH FL
32250-4819
US

V. Phone/Fax

Practice location:
  • Phone: 904-249-8893
  • Fax: 904-372-0496
Mailing address:
  • Phone: 904-249-8893
  • Fax: 904-372-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA4951
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JANET S MOULTON
Title or Position: OWNER
Credential: SLP
Phone: 904-249-8893