Healthcare Provider Details

I. General information

NPI: 1275083206
Provider Name (Legal Business Name): INNER STRENGTH PHYSICAL THERAPY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 TARPON BAY CT
PONTE VEDRA FL
32081-1505
US

IV. Provider business mailing address

64 TARPON BAY CT
PONTE VEDRA FL
32081-1505
US

V. Phone/Fax

Practice location:
  • Phone: 440-463-6272
  • Fax:
Mailing address:
  • Phone: 440-463-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT27447
License Number StateFL

VIII. Authorized Official

Name: SAMANTHA JOY MOON
Title or Position: PHYSICAL THERAPIST, OWNER
Credential: DPT
Phone: 440-463-6272