Healthcare Provider Details

I. General information

NPI: 1487610176
Provider Name (Legal Business Name): JOHN MARCUS PYATT P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101-1 COLLEGE ST
JACKSONVILLE FL
32205-5318
US

IV. Provider business mailing address

4373 WORTH DR W
JACKSONVILLE FL
32207-7501
US

V. Phone/Fax

Practice location:
  • Phone: 904-387-0370
  • Fax: 904-387-0156
Mailing address:
  • Phone: 904-739-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT16754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: