Healthcare Provider Details

I. General information

NPI: 1821745472
Provider Name (Legal Business Name): STEFANI MEJIA PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 KINGSLEY AVE STE 5
ORANGE PARK FL
32073-5129
US

IV. Provider business mailing address

8141 KILWINNING LN
JACKSONVILLE FL
32244-5517
US

V. Phone/Fax

Practice location:
  • Phone: 904-272-2830
  • Fax: 904-272-8814
Mailing address:
  • Phone: 904-504-2499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT38398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: