Healthcare Provider Details

I. General information

NPI: 1295351971
Provider Name (Legal Business Name): JANET MOULTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13241 BARTRAM PARK BLVD UNIT 1913
JACKSONVILLE FL
32258-5228
US

IV. Provider business mailing address

340 16TH AVE N STE B
JACKSONVILLE BEACH FL
32250-4819
US

V. Phone/Fax

Practice location:
  • Phone: 904-249-8893
  • Fax: 904-372-0496
Mailing address:
  • Phone: 904-249-8893
  • Fax: 904-372-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE LAVERGNE
Title or Position: BILLING AGENT
Credential:
Phone: 904-879-4230