Healthcare Provider Details

I. General information

NPI: 1346764412
Provider Name (Legal Business Name): HORACE STEEN WOODLAND III PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10423 CENTURION PKWY N
JACKSONVILLE FL
32256-0527
US

IV. Provider business mailing address

1526 BRUSH HOLLOW RD
HATFIELD PA
19440-2139
US

V. Phone/Fax

Practice location:
  • Phone: 904-854-2090
  • Fax:
Mailing address:
  • Phone: 215-720-4156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT40145
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE011394
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: