Healthcare Provider Details

I. General information

NPI: 1912379959
Provider Name (Legal Business Name): SELECT MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10680 OLD SAINT AUGUSTINE RD
JACKSONVILLE FL
32257-1000
US

IV. Provider business mailing address

10680 OLD SAINT AUGUSTINE RD
JACKSONVILLE FL
32257-1000
US

V. Phone/Fax

Practice location:
  • Phone: 904-268-4953
  • Fax:
Mailing address:
  • Phone: 904-268-4953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPTA25570
License Number StateFL

VIII. Authorized Official

Name: MR. BRIGHAM NATHANIEL GRIEVE
Title or Position: PHYSICAL THERAPIST ASSISTANT
Credential:
Phone: 904-268-4953