Healthcare Provider Details

I. General information

NPI: 1659821767
Provider Name (Legal Business Name): MARGO SLOVIS PT, DPT, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/04/2022
Certification Date: 10/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SPANISH MARSH DR
SAINT AUGUSTINE FL
32095-7405
US

IV. Provider business mailing address

164 SPANISH MARSH DR
SAINT AUGUSTINE FL
32095-7405
US

V. Phone/Fax

Practice location:
  • Phone: 443-983-4627
  • Fax:
Mailing address:
  • Phone: 443-983-4627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number31269
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number31269
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number31269
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: