Healthcare Provider Details

I. General information

NPI: 1326035924
Provider Name (Legal Business Name): CPT OF JACKSONVILLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 UNIVERSITY BLVD S SUITE 4
JACKSONVILLE FL
32216-4355
US

IV. Provider business mailing address

3716 UNIVERSITY BLVD S SUITE 4
JACKSONVILLE FL
32216-4355
US

V. Phone/Fax

Practice location:
  • Phone: 904-733-8133
  • Fax:
Mailing address:
  • Phone: 904-733-8133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. SAM ROGOZINSKI
Title or Position: CEO
Credential:
Phone: 904-733-8133