Healthcare Provider Details

I. General information

NPI: 1891948774
Provider Name (Legal Business Name): JENNIFER AMANDA JUSTICE DPT, SCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY JUSTICE DPT, SCS

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 05/24/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 PEORIA RD STE 203
ORANGE PARK FL
32065-7686
US

IV. Provider business mailing address

2216 GREEN HERON CT
FLEMING ISLAND FL
32003-8600
US

V. Phone/Fax

Practice location:
  • Phone: 904-657-0089
  • Fax: 904-560-5283
Mailing address:
  • Phone: 904-434-5737
  • Fax: 904-560-5283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT28237
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28237
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: