Healthcare Provider Details

I. General information

NPI: 1568188977
Provider Name (Legal Business Name): JOHN WESLEY DAUGHDRILL III DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6258 N W ST STE 2
PENSACOLA FL
32505-1903
US

IV. Provider business mailing address

220 W CHASE ST APT 302B
PENSACOLA FL
32502-5762
US

V. Phone/Fax

Practice location:
  • Phone: 850-904-4344
  • Fax:
Mailing address:
  • Phone: 601-382-3452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39133
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: