Healthcare Provider Details

I. General information

NPI: 1578089983
Provider Name (Legal Business Name): LEGENDARY PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N PALAFOX ST
PENSACOLA FL
32501-3919
US

IV. Provider business mailing address

PO BOX 6568
PENSACOLA FL
32503-0568
US

V. Phone/Fax

Practice location:
  • Phone: 850-332-7681
  • Fax: 850-512-1188
Mailing address:
  • Phone: 850-478-1312
  • Fax: 850-474-9060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. LOUIE WATKINS III
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT, COMT
Phone: 850-380-4377