Healthcare Provider Details

I. General information

NPI: 1003116476
Provider Name (Legal Business Name): SHEYNA MYNTTI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 SAN MARCO AVE
SAINT AUGUSTINE FL
32084-2762
US

IV. Provider business mailing address

207 SAN MARCO AVE
SAINT AUGUSTINE FL
32084-2762
US

V. Phone/Fax

Practice location:
  • Phone: 904-827-2563
  • Fax:
Mailing address:
  • Phone: 904-827-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 22360
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: