Healthcare Provider Details

I. General information

NPI: 1861619702
Provider Name (Legal Business Name): SUSAN BORYS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6248 103RD ST
JACKSONVILLE FL
32210-7733
US

IV. Provider business mailing address

2055 GROVE BLUFF RD
JACKSONVILLE FL
32259-9247
US

V. Phone/Fax

Practice location:
  • Phone: 904-573-0046
  • Fax: 904-573-0772
Mailing address:
  • Phone: 904-230-7851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: