Healthcare Provider Details

I. General information

NPI: 1477861300
Provider Name (Legal Business Name): STEPHANIE PURCELL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 US HIGHWAY 17 SUITE B3
ORANGE PARK FL
32003-8233
US

IV. Provider business mailing address

3425 EXECUTIVE PKWY SUITE 128
TOLEDO OH
43606-1326
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT25800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: