Healthcare Provider Details

I. General information

NPI: 1548861602
Provider Name (Legal Business Name): ACTION THERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE TERRACE OF IVY ACRES 3964 FLORIDA AVE
JAY FL
32565-1104
US

IV. Provider business mailing address

3331 SUMMIT BLVD APT 172
PENSACOLA FL
32503-4331
US

V. Phone/Fax

Practice location:
  • Phone: 850-741-6715
  • Fax:
Mailing address:
  • Phone: 850-741-6715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PAULLEY
Title or Position: MANAGING MEMBER
Credential: PT
Phone: 318-547-1090