Healthcare Provider Details

I. General information

NPI: 1396279576
Provider Name (Legal Business Name): JEFFREY AUSTEN BEDENBAUGH PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JEFFREY AUSTEN BEDENBAUGH PT,DPT

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10423 CENTURION PKWY N
JACKSONVILLE FL
32256-0527
US

IV. Provider business mailing address

3901 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4312
US

V. Phone/Fax

Practice location:
  • Phone: 904-854-2090
  • Fax:
Mailing address:
  • Phone: 904-345-7336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT32362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: