Healthcare Provider Details

I. General information

NPI: 1811095789
Provider Name (Legal Business Name): TEOFILO OBINA SIM III PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 BLANDING BLVD STE 305
MIDDLEBURG FL
32068-5650
US

IV. Provider business mailing address

2710 BLANDING BLVD STE 305
MIDDLEBURG FL
32068-5650
US

V. Phone/Fax

Practice location:
  • Phone: 904-282-8640
  • Fax:
Mailing address:
  • Phone: 904-282-8640
  • Fax: 904-282-8696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19211
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: