Healthcare Provider Details

I. General information

NPI: 1336337864
Provider Name (Legal Business Name): ATLANTIC COAST PHYSICAL THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13595 ATLANTIC BLVD SUITE B
JACKSONVILLE FL
32225-3256
US

IV. Provider business mailing address

13595 ATLANTIC BLVD SUITE B
JACKSONVILLE FL
32225-3256
US

V. Phone/Fax

Practice location:
  • Phone: 904-221-4046
  • Fax: 904-221-4056
Mailing address:
  • Phone: 904-221-4046
  • Fax: 904-221-4056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT20519
License Number StateFL

VIII. Authorized Official

Name: MR. DELL A JARVIS
Title or Position: DIRECTOR
Credential: PTA
Phone: 904-221-4046