Healthcare Provider Details

I. General information

NPI: 1053305748
Provider Name (Legal Business Name): SOUTHERN THERAPIES OF NORTH FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6050 SAINT JOHNS AVE SUITE 1
PALATKA FL
32177-3895
US

IV. Provider business mailing address

6050 SAINT JOHNS AVE SUITE 1
PALATKA FL
32177-3895
US

V. Phone/Fax

Practice location:
  • Phone: 386-312-0022
  • Fax: 386-312-0535
Mailing address:
  • Phone: 386-312-0022
  • Fax: 386-312-0535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: AMANDA BENNETT
Title or Position: BILLING AGENT
Credential:
Phone: 386-312-0022