Healthcare Provider Details

I. General information

NPI: 1053825372
Provider Name (Legal Business Name): VICTORIA CHRISTINE MORROW PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 CENTURION PKWY N STE 220
JACKSONVILLE FL
32256-5004
US

IV. Provider business mailing address

6500 BOWDEN RD STE 103
JACKSONVILLE FL
32216-8066
US

V. Phone/Fax

Practice location:
  • Phone: 904-634-0640
  • Fax:
Mailing address:
  • Phone: 904-634-0640
  • Fax: 904-674-6155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA28018
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: